Organization
OKALOOSA SURGICAL ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM MICHAEL HANEY MD (PHYSICIAN)
(850) 678-6601
Entity
Organization
Contact information
Practice address
550 TWIN CITIES BLVD, SUITE C, NICEVILLE, FL 32578
(850) 678-6601
(850) 678-0842
Mailing address
550 TWIN CITIES BLVD, SUITE C, NICEVILLE, FL 32578
(850) 678-6601
(850) 678-0842
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME0055821
FL
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194810762
NPI
FL
05
—
370716400
—
FL
Enumeration date
10/03/2006
Last updated
09/16/2010
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