Basic Information
| Provider Information | |||||||||
| NPI: | 1043454960 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST FLORIDA PATHOLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5901 SW 74TH ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331435165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056662427 | ||||||||
| FaxNumber: | 3056661065 | ||||||||
| Practice Location | |||||||||
| Address1: | 8383 N DAVIS HWY | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325146039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056662427 | ||||||||
| FaxNumber: | 3056670239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2009 | ||||||||
| LastUpdateDate: | 04/22/2009 | ||||||||
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| AuthorizedOfficialLastName: | MCFADDEN | ||||||||
| AuthorizedOfficialFirstName: | NORMAN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3056662427 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.