Organization
FORT WALTON BEACH ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDY POPPLE (EXECUTIVE DIRECTOR)
(850) 474-8000
Entity
Organization
Contact information
Practice address
1000 MAR WALT DR, FORT WALTON BEACH, FL 32547-6708
(850) 474-8688
(850) 969-2910
Mailing address
8201 UNIVERSITY PKWY, PENSACOLA, FL 32514-4904
(850) 474-8688
(850) 969-2910
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24572
BLUE SHIELD
FL
05
—
266456900
—
FL
01
—
CK6290
RAILROAD MEDICARE
—
Enumeration date
10/28/2005
Last updated
06/24/2008
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