Organization
4MD2 PHYSICIAN SERVICES OF FORT WALTON BEACH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GUY DUWANE HOOPER (PRESIDENT)
(205) 437-6098
Entity
Organization
Contact information
Practice address
1000 MAR WALT DR, FORT WALTON BEACH, FL 32547-6708
(850) 863-7607
(205) 437-5998
Mailing address
PO BOX 88452, CHICAGO, IL 60680-1452
(205) 437-6098
(205) 437-5998
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2622096
UNITEDHEALTHCARE OF FL
FL
01
—
7800781
AETNA GROUP PROVIDER NO
FL
01
—
97859
BCBS GROUP NUMBER
FL
01
—
DE2947
RRMC GROUP NUMBER
FL
01
—
F938
BCBS GROUP PROVIDER NO
AL
Enumeration date
05/03/2006
Last updated
07/20/2007
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