Organization
PANHANDLE ORTHOPAEDICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL D GILMORE MD (PRESIDENT/OWNER)
(850) 398-8480
Entity
Organization
Contact information
Practice address
12909 PANAMA CITY BEACH PKWY, PANAMA CITY BEACH, FL 32407
(850) 784-7724
(850) 784-4711
Mailing address
710 HOSPITAL DR, CRESTVIEW, FL 32539-7380
(850) 398-8480
(850) 398-8482
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
FL
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
FL
2080S0010X
Pediatric Sports Medicine Physician
—
FL
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
—
FL
225100000X
Physical Therapist
—
FL
2251X0800X
Orthopedic Physical Therapist
—
FL
225200000X
Physical Therapy Assistant
—
FL
363A00000X
Physician Assistant
—
FL
363AS0400X
Surgical Physician Assistant
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004K2
BLUE CROSS BLUE SHIELD OF FLORIDA
FL
Enumeration date
11/26/2012
Last updated
08/23/2018
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