Provider Demographics
NPI:1013000165
Name:GULF COAST ORTHOPEDIC SPECIALISTS PA
Entity Type:Organization
Organization Name:GULF COAST ORTHOPEDIC SPECIALISTS PA
Other - Org Name:GULF COAST ORTHOPEDIC SPECIALISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:SURGEON PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-494-9000
Mailing Address - Street 1:4541 N DAVIS HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503
Mailing Address - Country:US
Mailing Address - Phone:850-494-9000
Mailing Address - Fax:850-479-4258
Practice Address - Street 1:4541 N DAVIS HWY
Practice Address - Street 2:SUITE A
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503
Practice Address - Country:US
Practice Address - Phone:850-494-9000
Practice Address - Fax:850-479-4258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044171600Medicaid
FL244684OtherUNITED HEALTHCARE
FL00788OtherBCBS FLORIDA
AL590C078OtherBCBS ALABAMA
FLCL2119OtherMEDICARE RAILROAD
FL244684OtherUNITED HEALTHCARE
FL044171600Medicaid
FL00788Medicare PIN