Basic Information
Provider Information
NPI: 1881923118
EntityType: 2
ReplacementNPI:  
OrganizationName: NAUTILUS HEALTH CARE GROUP PA PC
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Mailing Information
Address1: PO BOX 530968
Address2:  
City: ST PETERSBURG
State: FL
PostalCode: 337470968
CountryCode: US
TelephoneNumber: 7278232188
FaxNumber: 7278280723
Practice Location
Address1: 211 E 7TH ST
Address2: STE 620
City: AUSTIN
State: TX
PostalCode: 787013218
CountryCode: US
TelephoneNumber: 7278675480
FaxNumber: 7278675470
Other Information
ProviderEnumerationDate: 12/16/2009
LastUpdateDate: 04/27/2010
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AuthorizedOfficialLastName: MORRISON
AuthorizedOfficialFirstName: CHRISTOPHER
AuthorizedOfficialMiddleName: A
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 7278675480
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: NAUTILUS HEALTH CARE GROUP PA
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AuthorizedOfficialCredential: MD
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WW0000XN3910TXN193200000X MULTI-SPECIALTY GROUPNursing Service ProvidersRegistered NurseWound Care
207NS0135XN3910TXN193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
2083P0011XN3910TXY193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine

No ID Information.


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