| Gulf Coast Physician Partners | |
|
5992 Berryhill Rd Ste 300 Milton FL 32570-1014 | |
| (850) 623-9787 | |
| (850) 626-7512 |
| Full Name | Gulf Coast Physician Partners |
|---|---|
| Speciality | Family Medicine |
| Location | 5992 Berryhill Rd Ste 300, Milton, Florida |
| Authorized Official Name and Position | Janet Irene Lewis (PRESIDENT, GULF COAST PHYSICIAN PAR) |
| Authorized Official Contact | 8506239787 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gulf Coast Physician Partners 5992 Berryhill Rd Suite 300 Milton FL 32570-1013 Ph: (850) 623-9787 | Gulf Coast Physician Partners 5992 Berryhill Rd Ste 300 Milton FL 32570-1014 Ph: (850) 623-9787 |
| NPI Number | 1679589428 |
|---|---|
| Provider Enumeration Date | 08/01/2006 |
| Last Update Date | 12/04/2009 |
| Medicare PECOS PAC ID | 5597751776 |
|---|---|
| Medicare Enrollment ID | O20040422001245 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679589428 | NPI | - | NPPES |
| 3718531 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Joseph D Fountain |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225042864 PECOS PAC ID: 4688689250 Enrollment ID: I20060217000634 |
| Provider Name | Bach-uyen Lethi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831251222 PECOS PAC ID: 8820154198 Enrollment ID: I20100201000477 |
| Provider Name | Janet Lewis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457362287 PECOS PAC ID: 3375539570 Enrollment ID: I20100201000496 |
| Provider Name | Dennis Mayeaux |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528079340 PECOS PAC ID: 9931195138 Enrollment ID: I20100201000512 |
| Provider Name | Devonn L Bourg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467919928 PECOS PAC ID: 1759615651 Enrollment ID: I20190626003239 |
| Provider Name | Travis Logan Larson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417482373 PECOS PAC ID: 5597038190 Enrollment ID: I20200616000887 |
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