Organization
OKALOOSA CARDIOLOGY P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA M GIBSON (BILLING MANAGER)
(850) 682-7212
Entity
Organization
Contact information
Practice address
129 E REDSTONE AVE, SUITE A, CRESTVIEW, FL 32539-5350
(850) 682-7212
Mailing address
129 E REDSTONE AVE, SUITE A, CRESTVIEW, FL 32539-5350
(850) 682-7212
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
258928100
—
FL
Enumeration date
05/11/2006
Last updated
08/25/2011
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