Organization
SPACE COAST EMERGENCY PHYSICIANS PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL MCGOOHAN DO (PRESIDENT)
(866) 396-6416
Entity
Organization
Contact information
Practice address
701 W COCOA BEACH CSWY, COCOA BEACH, FL 32931-3585
(321) 799-7111
Mailing address
PO BOX 918994, ORLANDO, FL 32891-8994
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
94825
BCBS GROUP
FL
01
—
DD1357
RR MCR GROUP
FL
Enumeration date
09/15/2005
Last updated
08/22/2020
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