| |
5190 Bayou Blvd Bldg 2 Pensacola FL 32503-2194 | |
(850) 476-0003 | |
(850) 476-4724 |
Full Name | |
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Speciality | Family Medicine |
Location | 5190 Bayou Blvd, Pensacola, Florida |
Authorized Official Name and Position | William C Wilson (PRESIDENT) |
Authorized Official Contact | 8504760003 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5190 Bayou Blvd Bldg 2 Pensacola FL 32503-2194 Ph: (850) 476-0003 | 5190 Bayou Blvd Bldg 2 Pensacola FL 32503-2194 Ph: (850) 476-0003 |
NPI Number | 1437185923 |
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Provider Enumeration Date | 06/25/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1437185923 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | OS5519 (Florida) | Primary |
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