Organization
SOUTHERN ORTHOPAEDICS AND SPORTS MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY A RYSULA (OFFICE MANAGER)
(850) 432-3293
Entity
Organization
Contact information
Practice address
1823 N 9TH AVE STE 534, PENSACOLA, FL 32503-5270
(850) 432-3293
(850) 469-9113
Mailing address
1823 N 9TH AVE STE 534, PENSACOLA, FL 32503-5270
(850) 432-3293
(850) 469-9113
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
263501100
—
FL
05
—
529200280
—
AL
Enumeration date
09/20/2006
Last updated
02/24/2020
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