Organization
ABC PEDIATRICS OF OKALOOSA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE MITCHELL (OFFICE MANAGER)
(850) 689-0900
Entity
Organization
Contact information
Practice address
182 E. REDSTONE AVE, SUITE B, CRESTVIEW, FL 32539
(850) 689-0900
(850) 689-0912
Mailing address
2260 S FERDON BLVD, BOX 92, CRESTVIEW, FL 32536-8457
(850) 689-0900
(850) 689-0912
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
ME70831
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250009400
—
FL
Enumeration date
10/02/2015
Last updated
10/02/2015
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