Provider Demographics
NPI:1124009477
Name:PENSACOLA PULMONARY ASSOCIATES P.A.
Entity Type:Organization
Organization Name:PENSACOLA PULMONARY ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-471-8454
Mailing Address - Street 1:PO BOX 11515
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32524-1515
Mailing Address - Country:US
Mailing Address - Phone:850-471-8454
Mailing Address - Fax:850-471-3410
Practice Address - Street 1:8333 N DAVIS HWY
Practice Address - Street 2:SUITE 6005
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6050
Practice Address - Country:US
Practice Address - Phone:850-471-8454
Practice Address - Fax:850-471-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K2956Medicare ID - Type Unspecified