Organization
PENSACOLA RADIOLOGY CONSULTANTS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY J. DERAIMO M.D. (PRESIDENT)
(850) 476-8602
Entity
Organization
Contact information
Practice address
5151 N 9TH AVE, PENSACOLA, FL 32504-8721
(850) 416-6020
Mailing address
PO BOX 9210, PENSACOLA, FL 32513-9210
(850) 476-8602
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00619
GROUP BCBS OF FL
FL
05
—
054682800
—
FL
05
—
529001290
—
AL
01
—
CD4629
RR MEDICARE
FL
Enumeration date
07/06/2006
Last updated
07/21/2022
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