Provider Demographics
NPI:1427364405
Name:EMERALD COAST OBSTETRICS & GYNECOLOGY, P.A.
Entity Type:Organization
Organization Name:EMERALD COAST OBSTETRICS & GYNECOLOGY, P.A.
Other - Org Name:EMERALD COAST OBGYN, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-769-0338
Mailing Address - Street 1:103 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4501
Mailing Address - Country:US
Mailing Address - Phone:850-769-0338
Mailing Address - Fax:850-785-6088
Practice Address - Street 1:103 E 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4501
Practice Address - Country:US
Practice Address - Phone:850-769-0338
Practice Address - Fax:850-785-6088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002699900Medicaid