Organization
PANHANDLE SURGICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DOTTIE CLARK (MANAGER)
(850) 640-3320
Entity
Organization
Contact information
Practice address
2202 STATE AVE, STE 104, PANAMA CITY, FL 32405-7601
(850) 640-3320
Mailing address
2202 STATE AVE, STE 104, PANAMA CITY, FL 32405-7601
(850) 640-3320
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME102627
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1528213394
INDIVIDUAL PROVIDER NPI
FL
Enumeration date
09/29/2016
Last updated
03/28/2017
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