Organization
MCMAHON & RICKETSON MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KURT T. STOCKAMP M.D. (PRESIDENT)
(850) 476-6110
Entity
Organization
Contact information
Practice address
5147 N 9TH AVE, STE. 203, PENSACOLA, FL 32504-8771
(850) 476-6110
(850) 479-6042
Mailing address
5147 N 9TH AVE, STE. 203, PENSACOLA, FL 32504-8771
(850) 476-6110
(850) 479-6042
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
269452200
MEDICAID
FL
01
—
45688
BCBS
FL
01
—
528302480
AL MEDICAID
AL
Enumeration date
08/08/2006
Last updated
06/16/2010
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