Organization
FT. WALTON BEACH GENERAL SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICKEY PICKLER (VP)
(850) 864-3232
Entity
Organization
Contact information
Practice address
1775 LEWIS TURNER BLVD, #102, FT WALTON BEACH, FL 32547-1221
(850) 864-3232
Mailing address
1775 LEWIS TURNER BLVD, #102, FT WALTON BEACH, FL 32547-1221
(850) 864-3232
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
06/15/2006
Last updated
09/11/2007
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