Organization
4MD2 PHYSICIAN SERVICES OF NICEVILLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GUY DUWANE HOOPER (PRESIDENT)
(205) 437-6098
Entity
Organization
Contact information
Practice address
2190 HIGHWAY 85 N, NICEVILLE, FL 32578-1045
(850) 729-9490
(205) 437-5998
Mailing address
PO BOX 88490, CHICAGO, IL 60680-1490
(205) 437-6098
(205) 437-5998
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2621276
UNITEDHEALTHCARE OF FL
FL
01
—
7946836
AETNA GROUP NO
FL
01
—
97861
GROUP BCBS NUMBER
FL
01
—
DE3244
GROUP RRMC NUMBER
FL
01
—
F952
BCBS GROUP NO
AL
Enumeration date
05/15/2006
Last updated
07/20/2007
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