Organization
MEDICAL PROFESSIONAL AGENCY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA ROGERS (BILLING COORDINATOR)
(850) 623-2948
Entity
Organization
Contact information
Practice address
9400 UNIVERSITY PKWY, 101C, PENSACOLA, FL 32514-5752
(850) 623-2948
(850) 626-2734
Mailing address
PO BOX 893, MILTON, FL 32572-0893
(850) 623-2948
(850) 626-2734
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24847
BLUE CROSS BLUE SHIELD
FL
05
—
254839924
—
FL
01
—
CC1458
RAILROAD MEDICARE
FL
Enumeration date
03/21/2007
Last updated
04/30/2010
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