Basic Information
Provider Information | |||||||||
NPI: | 1629054150 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TURNER | ||||||||
FirstName: | DAVID | ||||||||
MiddleName: | A. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2114 AIRPORT BLVD | ||||||||
Address2: | SUITE 1000 | ||||||||
City: | PENSACOLA | ||||||||
State: | FL | ||||||||
PostalCode: | 325048926 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8504763696 | ||||||||
FaxNumber: | 8504773573 | ||||||||
Practice Location | |||||||||
Address1: | 2114 AIRPORT BLVD | ||||||||
Address2: | SUITE 1000 | ||||||||
City: | PENSACOLA | ||||||||
State: | FL | ||||||||
PostalCode: | 325048926 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8504763696 | ||||||||
FaxNumber: | 8504773573 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/16/2005 | ||||||||
LastUpdateDate: | 07/29/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME36922 | FL | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | P00079790 | 01 | FL | MEDICARE RAILROAD | OTHER | 59168533 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER | 039501300 | 05 | FL |   | MEDICAID | 17480 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | Z020 | 01 | FL | HEALTH FIRST NETWORK | OTHER |