Provider Demographics
NPI:1134321920
Name:ALLERGY & ASTHMA CENTER OF NORTHWEST FLORIDA PA
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA CENTER OF NORTHWEST FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:WESTBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-473-1121
Mailing Address - Street 1:6160 N DAVIS HWY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6994
Mailing Address - Country:US
Mailing Address - Phone:850-473-1121
Mailing Address - Fax:
Practice Address - Street 1:6160 N DAVIS HWY
Practice Address - Street 2:SUITE 3
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6994
Practice Address - Country:US
Practice Address - Phone:850-473-1121
Practice Address - Fax:850-473-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50994174400000X
207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41528OtherBLUE CROSS BLUE SHIELD FL
FL990012277OtherRAILROAD MEDICARE
FL252381700Medicaid
FLK1311Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FL41528OtherBLUE CROSS BLUE SHIELD FL