Organization
KETCHUM WOOD & BURGERT CHARTERED DRS KETCHUM WOOD & BURGERT
Active
Parent organization
KETCHUM WOOD & BURGERT CHARTERED DRS KETCHUM WOOD & BURGERT
Organization subpart
Yes
Provider details
NPI number
Legal business name
KETCHUM WOOD & BURGERT CHARTERED DRS KETCHUM WOOD & BURGERT
Authorized official
MRS. ANGELA FUQUA (ADMINISTRATOR)
(850) 219-7603
Entity
Organization
Contact information
Practice address
1899 EIDER CT, TALLAHASSEE, FL 32308-4537
(850) 878-5143
(850) 942-6622
Mailing address
1899 EIDER CT, TALLAHASSEE, FL 32308-4537
(850) 878-5143
(850) 942-6622
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
800000042
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00018
BC/BS HOSPITAL BASED SERV
FL
05
—
030063201
—
FL
01
—
CF6643
RAILROAD MEDICARE
FL
Enumeration date
02/03/2006
Last updated
05/15/2020
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