Organization
PENSACOLA PEDIATRICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER HECKATHORN (ADMINISTRATOR)
(850) 473-0100
Entity
Organization
Contact information
Practice address
1368 COUNTRY CLUB RD, GULF BREEZE, FL 32563-3471
(850) 934-9876
(850) 916-0736
Mailing address
4951 GRANDE DR, PENSACOLA, FL 32504-8965
(850) 473-0100
(850) 473-0500
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
063018701
—
FL
Enumeration date
07/29/2021
Last updated
07/29/2021
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