Organization
SOUTH WALTON MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD BRUCE CAUSTON MD (OWNER/PHYSICIAN)
(850) 837-8005
Entity
Organization
Contact information
Practice address
10005C US HIGHWAY 98 W, DESTIN, FL 32550-4962
(850) 837-8005
(850) 837-4352
Mailing address
10005C US HIGHWAY 98 W, DESTIN, FL 32550-4962
(850) 837-8005
(850) 837-4352
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
FLME43330
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
265468700
—
FL
01
—
46168
BC BS
FL
Enumeration date
03/10/2008
Last updated
02/03/2009
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