Organization
4MD2 IN PATIENT PHYSICIAN SERVICES OF FORT WALTON BEACH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GUY DUWANE HOOPER (PRESIDENT)
(205) 437-6098
Entity
Organization
Contact information
Practice address
1000 MAR WALT DR, SUITE 266, FORT WALTON BEACH, FL 32547-6708
(850) 863-7607
(205) 437-5998
Mailing address
PO BOX 88477, CHICAGO, IL 60680-1477
(205) 437-6098
(205) 437-5998
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2625352
UNITEDHEALTHCARE GROUP NO
FL
01
—
7532779
AETNA GROUP NO
FL
01
—
97919
GROUP BCBS NUMBER
FL
01
—
DE2953
GROUP RRMC NUMBER
FL
01
—
G017
BCBS GROUP PROVIDER NO
AL
Enumeration date
05/15/2006
Last updated
07/20/2007
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