Organization
BLUEWATER BAY UROLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICKEY PICKLER (VICE PRESIDENT)
(850) 523-2117
Entity
Organization
Contact information
Practice address
4566 E HIGHWAY 20, SUITE 102, NICEVILLE, FL 32578-8838
(850) 897-6005
(850) 897-6003
Mailing address
4566 E HIGHWAY 20, SUITE 102, NICEVILLE, FL 32578-8838
(850) 897-6005
(850) 897-6003
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Enumeration date
06/19/2006
Last updated
01/10/2008
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