Provider Demographics
NPI:1922100452
Name:FAMILY MEDICINE ASSOCIATES OF THE GULF COAST PLLC
Entity Type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES OF THE GULF COAST PLLC
Other - Org Name:PAMELA J. SVENDSEN, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROPIERTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:SVENDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-936-8343
Mailing Address - Street 1:PO BOX 6479
Mailing Address - Street 2:8990 ORTEGA PARK DR
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-2079
Mailing Address - Country:US
Mailing Address - Phone:850-936-8343
Mailing Address - Fax:850-936-5338
Practice Address - Street 1:8990 ORTEGA PARK DR
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-4141
Practice Address - Country:US
Practice Address - Phone:850-936-8343
Practice Address - Fax:850-936-5338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL94822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9435Medicare ID - Type UnspecifiedFMAGC GROUP NUMBER
FLG84062Medicare UPIN