Provider Demographics
NPI:1346534518
Name:EMERALD COAST PM&R ASSOCIATES, PA
Entity Type:Organization
Organization Name:EMERALD COAST PM&R ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-647-7178
Mailing Address - Street 1:6901A N 9TH AVE STE 198
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6638
Mailing Address - Country:US
Mailing Address - Phone:956-647-7178
Mailing Address - Fax:850-474-9060
Practice Address - Street 1:1101 OFFICE WOODS DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5937
Practice Address - Country:US
Practice Address - Phone:850-956-6477
Practice Address - Fax:850-474-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91918208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty