| Bluewater Medicine | |
|
4566 E Highway 20 Ste 103 Niceville FL 32578-8839 | |
| (850) 897-1223 | |
| (850) 897-1237 |
| Full Name | Bluewater Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 4566 E Highway 20 Ste 103, Niceville, Florida |
| Authorized Official Name and Position | Kenneth Wayne Ponder (PRESIDENT) |
| Authorized Official Contact | 8505177877 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bluewater Medicine 4704 Knollwood Rd Niceville FL 32578-8760 Ph: (850) 517-7877 | Bluewater Medicine 4566 E Highway 20 Ste 103 Niceville FL 32578-8839 Ph: (850) 897-1223 |
| NPI Number | 1962593574 |
|---|---|
| Provider Enumeration Date | 09/27/2006 |
| Last Update Date | 12/29/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962593574 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME0063310 (Florida) | Primary |
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