Provider Demographics
NPI:1992847230
Name:GULF COAST ORTHOPEDIC SPECIALISTS
Entity Type:Organization
Organization Name:GULF COAST ORTHOPEDIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON-PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-494-9000
Mailing Address - Street 1:4541 N DAVIS HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2783
Mailing Address - Country:US
Mailing Address - Phone:850-494-9000
Mailing Address - Fax:
Practice Address - Street 1:1040 GULF BREEZE PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4838
Practice Address - Country:US
Practice Address - Phone:850-932-9401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN TAX ID
FL=========OtherEIN TAX ID