Provider Demographics
NPI:1679509194
Name:NAVARRE PEDIATRICS PL
Entity Type:Organization
Organization Name:NAVARRE PEDIATRICS PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HEBA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELGOWENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-939-5550
Mailing Address - Street 1:8880 NAVARRE PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-3613
Mailing Address - Country:US
Mailing Address - Phone:850-939-5550
Mailing Address - Fax:850-939-5445
Practice Address - Street 1:8880 NAVARRE PKWY STE 102
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-3613
Practice Address - Country:US
Practice Address - Phone:850-939-5550
Practice Address - Fax:850-939-5445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL591-68789OtherBLUE CROSS BLUE SHIELD OF ALABAMA
FL268997900Medicaid
FL34960OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FL268997900Medicaid