Organization · Type 2 NPI
Coastal Vascular and Interventional PLLC
Vascular Surgery Physician · Fort Walton Beach, FL
NPI number
1164091005
Active
Practice location
1032 Mar Walt Dr Unit 250
Fort Walton Beach, FL 32547-6663
Fax (850) 479-1829
Mailing address
PO Box 11982
Pensacola, FL 32524-1982
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | None listed |
| Vascular & Interventional Radiology Physician | 2085R0204X | None listed |
| Vascular Surgery Physician Primary | 2086S0129X | None listed |
Vascular Surgery Physician: A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.
Another provider at this address
About NPI 1164091005
Coastal Vascular and Interventional PLLC's National Provider Identifier is 1164091005, issued on Jun 24, 2021. The primary taxonomy on file is Vascular Surgery Physician (2086S0129X), and the practice location is in Fort Walton Beach, FL. The record was last updated on Jun 24, 2021.