Provider Demographics
NPI:1588796635
Name:EDDIE A. NEGRON, M.D., P.A.
Entity Type:Organization
Organization Name:EDDIE A. NEGRON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:NEGRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-864-1771
Mailing Address - Street 1:PO BOX 960
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-0960
Mailing Address - Country:US
Mailing Address - Phone:850-864-1771
Mailing Address - Fax:850-864-1716
Practice Address - Street 1:921 MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6759
Practice Address - Country:US
Practice Address - Phone:850-864-1771
Practice Address - Fax:850-864-1716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME#49544207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02379OtherBLUE CROSS
FL02379Medicare ID - Type Unspecified
FLD50481Medicare UPIN