Organization
GULF COAST HOLISTIC AND PRIMARY CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAQUEL SKIDMORE MD (MEDICAL DIRECTOR)
(850) 640-1530
Entity
Organization
Contact information
Practice address
756 HARRISON AVE, PANAMA CITY, FL 32401-2524
(850) 640-1530
(850) 640-1630
Mailing address
756 HARRISON AVE, PANAMA CITY, FL 32401-2524
(850) 640-1530
(850) 640-1630
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
ACN244
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006732100
—
FL
Enumeration date
06/17/2014
Last updated
06/17/2014
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