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Organization

CLUB2,LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. PAUL ROEBUCK HENNING M.D (MEDICAL DIRECTOR)
(850) 696-9556
Entity
Organization

Contact information

Practice address
1230 CRANE COVE BLVD, GULF BREEZE, FL 32563-3191
(850) 934-6659
Mailing address
1175 MARY KATE DR, GULF BREEZE, FL 32563-5542
(850) 934-6659

Taxonomy

Speciality
Code
Description
License number
State
261QE0002X
Emergency Care Clinic/Center
Primary
ME93462
FL

Other

Enumeration date
04/22/2013
Last updated
04/22/2013
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