Organization
NORTHWEST FLORIDA ENT PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON REDWOOD BOOLE (PRESIDENT)
(850) 889-4550
Entity
Organization
Contact information
Practice address
310 RACETRACK RD NW STE 100, FORT WALTON BEACH, FL 32547-1553
(850) 889-4550
(850) 889-4549
Mailing address
310 RACETRACK RD NW, FORT WALTON BEACH, FL 32547-1553
(850) 889-4550
(850) 807-5217
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
ME96773
FL
207YS0012X
Sleep Medicine (Otolaryngology) Physician
ME96773
FL
207YX0602X
Otolaryngic Allergy Physician
ME96773
FL
Other
Enumeration date
09/12/2015
Last updated
04/13/2019
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