Organization
EMERALD COAST NEONATOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS SPRAGUE M.D. (PRESIDENT)
(850) 265-9332
Entity
Organization
Contact information
Practice address
4250 HOSPITAL DRIVE, MARIANNA, FL 32446
(850) 265-9332
(850) 784-7706
Mailing address
PO BOX 15789, PANAMA CITY, FL 32406
(850) 265-9332
(850) 784-7706
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
ME66820
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
260912600
—
FL
01
—
45706
BCBS FLORIDA
FL
Enumeration date
09/29/2006
Last updated
01/22/2009
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