Provider Demographics
NPI:1245351329
Name:J GRANT SHUFLITOWSKI MD PA GULF VIEW FAMILY MEDICAL CENTER
Entity type:Organization
Organization Name:J GRANT SHUFLITOWSKI MD PA GULF VIEW FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUFLITOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-234-1898
Mailing Address - Street 1:16900 FRONT BEACH RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-2345
Mailing Address - Country:US
Mailing Address - Phone:850-234-1898
Mailing Address - Fax:850-234-7670
Practice Address - Street 1:16900 FRONT BEACH RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-2345
Practice Address - Country:US
Practice Address - Phone:850-234-1898
Practice Address - Fax:850-234-7670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375337900Medicaid
FL375337900Medicaid
FLD78892Medicare UPIN