Individual
KYLE KIT SHADDIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5147 N 9TH AVE, STE 203, PENSACOLA, FL 32504-8771
(850) 476-7100
(850) 479-6042
Mailing address
5147 N 9TH AVE, STE. 203, PENSACOLA, FL 32504-8771
(850) 476-7100
(850) 479-6042
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
ME99596
FL
208600000X
Surgery Physician
ME99596
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003155317A
—
GA
05
—
013852500
—
FL
Enumeration date
08/08/2008
Last updated
07/26/2015
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