Organization
CRESTVIEW PEDIATRICS AND ADOLESCENT CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BERNADINE S PETER (OFFICE MGR)
(850) 683-5100
Entity
Organization
Contact information
Practice address
332 MEDCREST DRIVE, CRESTVIEW, FL 32536
(850) 683-5100
(850) 683-5102
Mailing address
332 MEDCREST DRIVE, CRESTVIEW, FL 32536
(850) 683-5100
(850) 683-5102
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME74916
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
94749
BCBS
FL
Enumeration date
12/27/2006
Last updated
08/22/2020
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