GULF COAST PODIATRY, PA (NPI# 1295745560) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295745560 |
| Entity Type | Organization |
| Organization Name | GULF COAST PODIATRY, PA |
| Practice Address |
2507 Harrison Ave Unit 201 Panama City FL 32405-4447 |
| Practice Telephone | 8507690325 |
| Practice Fax Number | 8507694476 |
| Mailing Telephone | 8507690325 |
| Mailing Fax Number | 8507694476 |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2019-01-07 |
| Authorized Official Name | SHAYNE JENSEN (PRESIDENT) |
| Authorized Official Telephone | 8507690325 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 213ES0131X |
Podiatrist Specialization: Foot Surgery |
Podiatric Medicine & Surgery Service Providers | ||
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BLUECROSSBLUESHIELD | 45803 | 01 |
| FL | RR MEDICARE | CK8386 | 01 |
| Street Address |
2507 HARRISON AVE UNIT 201 |
| City | PANAMA CITY |
| State | FL |
| Zip Code | 32405-4447 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326072398 | Michelle Hines Bautista | Nurse Practitioner | 2507 Harrison Ave Unit 201, Panama City, FL 32405-4447 | 2006-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457962136 | Kimberlea Fox | Behavioral Analyst | 4750 Collegiate Drive, Technology Building 157, Panama City, FL 32405 | 2020-08-14 |
| 1598325714 | Covenant Home Health Care, LLC | Home Health | 107 W. 19th Street, Panama City, FL 32405 | 2019-06-19 |
| 1467921403 | Amy Hancock | Counselor | 1212 W. 19th St., Panama City, FL 32405 | 2018-11-20 |
| 1063991917 | Patricia Kagendo Mutunga | Day Training, Developmentally Disabled Services | 2813 Fairmont Dr, Panama City, FL 32405 | 2018-08-11 |
| 1871087882 | Southeastern Dermatology Group Pa | Pharmacy | 2505 Harrison Ave Ste A, Panama City, FL 32405 | 2018-06-22 |
| 1346733615 | Jessica Nicole Graham | Nurse Practitioner | 2507 Harrison Ave Unit 101, Panama City, FL 32405 | 2018-06-12 |
| 1437658424 | Coastal Mobility Transportation, LLC | Non-emergency Medical Transport (VAN) | 203 Forest Park Circle, Panama City, FL 32405 | 2018-02-06 |
| 1003314915 | The Anti-aging Clinic of Northwest Florida | Obstetrics & Gynecology | 3019 Osprey Cir, Panama City, FL 32405 | 2018-01-25 |
| 1255848487 | Sarah Theriot | Social Worker | 700 W 23rd St Bldg H, Panama City, FL 32405 | 2018-01-09 |
| 1336686054 | Angela Leake | Registered Nurse | 449 W 23 St, Panama City, FL 32405 | 2017-01-20 |
| Find all providers in zip 32405 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407179856 | Adam Joseph Peaden | Podiatrist | 2201 Jenks Ave, Panama City, FL 32405-4531 | 2010-03-12 |
| 1205843463 | Daniel E Feitz | Podiatrist | 2424 Frankford Ave, Panama City, FL 32405-2239 | 2006-08-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720693120 | Mozhgan Alijani, Dpm, Pa | Podiatrist | 20515 E Country Club Dr Apt 544, Miami, FL 33180-3442 | 2020-09-11 |
| 1730790551 | Sacred Heart Hospital of Pensacola | Podiatrist | 1890 Summit Blvd, Pensacola, FL 32503 | 2020-08-14 |
| 1306457841 | Asdj LLC | Podiatrist | 2190 Bridgeport Cir, Rockledge, FL 32955-4338 | 2020-08-10 |
| 1316557762 | Upperline Healthcare, PC | Podiatrist | 2111 Glenwood Dr Ste 104, Winter Park, FL 32792-3328 | 2020-07-31 |
| 1790395135 | Upperline Healthcare, PC | Podiatrist | 339 Cypress Pkwy Ste 240, Kissimmee, FL 34759-3315 | 2020-07-31 |
| 1952911398 | Upperline Healthcare, PC | Podiatrist | 250 N Alafaya Trl Ste 115, Orlando, FL 32828-4336 | 2020-07-31 |
| 1639789076 | Upperline Healthcare, PC | Podiatrist | 650 S Courtenay Pkwy Ste 200, Merritt Island, FL 32952-4977 | 2020-07-31 |
| 1972113314 | Upperline Healthcare, PC | Podiatrist | 8000 Red Bug Lake Rd Ste 230, Oviedo, FL 32765-9265 | 2020-07-31 |
| 1356950646 | Palm Beach Foot & Ankle Inc | Podiatrist | 8130 Royal Palm Blvd Ste 205, Coral Springs, FL 33065-5703 | 2020-07-23 |
| 1720601891 | Yohandy Fuentes Dpm Pa | Podiatrist | 5200 Sw 8th St Ste 201a, Coral Gables, FL 33134-2337 | 2020-05-24 |
| Find all providers with the same taxonomy | ||||
| City | PANAMA CITY |
| Zip Code | 32405 |
Please comment or provide details below to improve the information on GULF COAST PODIATRY, PA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.