| Crestview Neurology | |
|
535 S Ferdon Blvd Suite C Crestview FL 32536-4446 | |
| (850) 423-4664 | |
| (850) 398-8824 |
| Full Name | Crestview Neurology |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 535 S Ferdon Blvd, Crestview, Florida |
| Authorized Official Name and Position | Shijun Pan (OWNER / PHYSICIAN) |
| Authorized Official Contact | 8504234664 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crestview Neurology 535 S Ferdon Blvd Suite C Crestview FL 32536-4237 Ph: (850) 423-4664 | Crestview Neurology 535 S Ferdon Blvd Suite C Crestview FL 32536-4446 Ph: (850) 423-4664 |
| NPI Number | 1194911768 |
|---|---|
| Provider Enumeration Date | 09/18/2007 |
| Last Update Date | 10/05/2012 |
| Medicare PECOS PAC ID | 7911082722 |
|---|---|
| Medicare Enrollment ID | O20080304000380 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194911768 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Shijun Pan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1245280858 PECOS PAC ID: 3971406570 Enrollment ID: I20080216000076 |
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