Organization
GULF COAST PODIATRY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAYNE JENSEN DMD (PRESIDENT)
(850) 769-0325
Entity
Organization
Contact information
Practice address
2507 HARRISON AVE UNIT 201, PANAMA CITY, FL 32405-4447
(850) 769-0325
(850) 769-4476
Mailing address
2507 HARRISON AVE UNIT 201, PANAMA CITY, FL 32405-4447
(850) 769-0325
(850) 769-4476
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
213ES0131X
Foot Surgery Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45803
BLUECROSSBLUESHIELD
FL
01
—
CK8386
RR MEDICARE
FL
Enumeration date
08/09/2006
Last updated
11/18/2020
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