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
4951 GRANDE DR, PENSACOLA, FL 32504-8965
(850) 473-0100
(850) 473-0500
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
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
063018700
—
FL
05
—
063018701
—
FL
Enumeration date
10/19/2006
Last updated
07/29/2021
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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