Provider Demographics
NPI:1588145890
Name:PANHANDLE ORTHOPAEDICS LLC
Entity type:Organization
Organization Name:PANHANDLE ORTHOPAEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DOW
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-398-8480
Mailing Address - Street 1:710 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-7380
Mailing Address - Country:US
Mailing Address - Phone:850-398-8480
Mailing Address - Fax:850-398-8482
Practice Address - Street 1:2401 LANGLEY AVE UNIT B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8922
Practice Address - Country:US
Practice Address - Phone:850-398-8480
Practice Address - Fax:850-398-8482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-24
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty