Organization
PEDIATRIC ASSOCIATES PA
Active
Parent organization
PEDIATRIC ASSOCIATES PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
PEDIATRIC ASSOCIATES PA
Authorized official
SHANNON DYER (CEO)
(850) 478-1104
Entity
Organization
Contact information
Practice address
12385 SORRENTO RD, SUITE C4, PENSACOLA, FL 32507-8664
(850) 478-1100
(850) 478-4289
Mailing address
12385 SORRENTO RD, PENSACOLA, FL 32507-8664
(850) 492-0257
(850) 492-8999
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
280234102
—
FL
Enumeration date
03/19/2013
Last updated
03/20/2013
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