Provider Demographics
NPI:1942561204
Name:PHILLIP H NUNNERY MD PA
Entity Type:Organization
Organization Name:PHILLIP H NUNNERY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:NUNNERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-763-5959
Mailing Address - Street 1:1936 JENKS AVENUE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405
Mailing Address - Country:US
Mailing Address - Phone:850-763-5959
Mailing Address - Fax:850-785-0574
Practice Address - Street 1:1936 JENKS AVENUE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:850-763-5959
Practice Address - Fax:850-785-0574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36299208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIQ878AMedicare PIN