Organization
SOUTHEASTERN OSTEOPOROSIS SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN D BAST P.A.-C. (PRESIDENT)
(850) 477-0775
Entity
Organization
Contact information
Practice address
4511 N DAVIS HWY, SUITE 1-C, PENSACOLA, FL 32503-2720
(850) 477-0775
Mailing address
4511 N DAVIS HWY, SUITE 1-C, PENSACOLA, FL 32503-2720
(850) 477-0775
Taxonomy
Speciality
Code
Description
License number
State
2471B0102X
Bone Densitometry Radiologic Technologist
Primary
JR3419100
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3405722
UNITED HEALTH CARE
FL
05
—
34252
—
AL
Enumeration date
08/17/2005
Last updated
08/22/2020
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