Organization
THEODORE I MACEY MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE I MACEY MD PA (PHYSICIAN)
(850) 863-2153
Entity
Organization
Contact information
Practice address
1034 MAR WALT DR STE 100, FORT WALTON BEACH, FL 32547-6645
(850) 863-2153
(850) 315-9350
Mailing address
1034 MAR WALT DR STE 100, FORT WALTON BEACH, FL 32547-6645
(850) 863-2153
(850) 315-9350
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
ME44008
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01449
BS PROVIDER NUMBER
FL
05
—
041896000
—
FL
01
—
200030432
RR MEDICARE
FL
01
—
DC6653
RR MEDICARE GROUP
FL
Enumeration date
02/12/2007
Last updated
04/28/2008
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