Organization
CHILD NEUROLOGY CENTER OF NORTHWEST FLORIDA PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES BEN RENFROE M.D. (OWNER)
(850) 932-5055
Entity
Organization
Contact information
Practice address
400 GULF BREEZE PKWY, SUITE 300, GULF BREEZE, FL 32561-4495
(850) 932-5055
(850) 932-1401
Mailing address
PO BOX 280, GULF BREEZE, FL 32562-0280
(850) 932-5055
(850) 932-1401
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
257889100
—
FL
05
—
529918930
—
AL
Enumeration date
11/07/2005
Last updated
01/20/2025
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