| Coastalmdlive, Llc | |
|
913 Gulf Breeze Pkwy Ste 3 Gulf Breeze FL 32561-4728 | |
| (850) 860-4679 | |
| Not Available |
| Full Name | Coastalmdlive, Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 913 Gulf Breeze Pkwy Ste 3, Gulf Breeze, Florida |
| Authorized Official Name and Position | Randy Neil (OWNER/PHYSICIAN) |
| Authorized Official Contact | 8508604679 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastalmdlive, Llc 913 Gulf Breeze Pkwy Ste 3 Gulf Breeze FL 32561-4728 Ph: (850) 860-4679 | Coastalmdlive, Llc 913 Gulf Breeze Pkwy Ste 3 Gulf Breeze FL 32561-4728 Ph: (850) 860-4679 |
| NPI Number | 1255039418 |
|---|---|
| Provider Enumeration Date | 02/17/2023 |
| Last Update Date | 02/17/2023 |
| Certification Date | 02/17/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255039418 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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