Organization
PANAMA CITY GENERAL SURGERY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHARON K BLAIR (A/R MANAGER)
(850) 763-3039
Entity
Organization
Contact information
Practice address
806 E 6TH ST, PANAMA CITY, FL 32401-3620
(850) 763-6224
(850) 872-1623
Mailing address
806 E 6TH ST, PANAMA CITY, FL 32401-3620
(850) 763-6224
(850) 872-1623
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0044185
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03619Z
MEDICARE PROVIDER NUMBER
FL
05
—
068584400
—
FL
01
—
1457310989
NIP
FL
01
—
24920
MEDICARE PTAN NUMBER
FL
Enumeration date
09/19/2007
Last updated
04/30/2009
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