Individual
DR. THEODORE I MACEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD PA
Contact information
Practice address
1034 MAR WALT DR STE 100, FORT WALTON BEACH, FL 32547-6645
(850) 863-2153
(850) 315-9350
Mailing address
1034 MAR WALT DR STE 100, FORT WALTON BEACH, FL 32547-6645
(850) 863-2153
(850) 315-9350
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ME44008
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041896000
—
FL
01
—
200030432
RR MEDICARE
FL
01
—
207X00000X
TAXONOMY NUMBER
FL
01
—
DC6653
RR MEDICARE GROUP
FL
Enumeration date
06/13/2005
Last updated
02/14/2013
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