Basic Information
| Provider Information | |||||||||
| NPI: | 1366437204 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VARENHOLT | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7458 PINE FOREST RD | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325268818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504748773 | ||||||||
| FaxNumber: | 8509410084 | ||||||||
| Practice Location | |||||||||
| Address1: | 7458 PINE FOREST RD | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325268818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504748773 | ||||||||
| FaxNumber: | 8509410084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2005 | ||||||||
| LastUpdateDate: | 12/22/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME0058363 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.