DR. RANDALL LOUIS MCKISSACK (NPI# 1487639621) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487639621 |
| Entity Type | Individual |
| Full Name | DR. RANDALL LOUIS MCKISSACK |
| Credential | M.D. |
| Practice Address |
999 Mar Walt Dr Fort Walton Beach FL 32547-6758 |
| Mailing Address |
801 E. 6th Street Suite 602 Panama City FL 32401-3663 |
| Practice Telephone | 8508638269 |
| Practice Fax Number | 8508627965 |
| Mailing Telephone | 8509136960 |
| Mailing Fax Number | 8509147065 |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2019-06-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | ME96715 | FL | Allopathic & Osteopathic Physicians |
| Street Address |
999 MAR WALT DR |
| City | FORT WALTON BEACH |
| State | FL |
| Zip Code | 32547-6758 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619979937 | Frank C Zondlo | Specialist | 999 Mar Walt Dr, Fort Walton Beach, FL 32547-6758 | 2005-06-01 |
| 1033473772 | Shawn Gerard Hughes | Anesthesiology | 999 Mar Walt Dr, Fort Walton Beach, FL 32547 | 2012-06-27 |
| 1720009046 | Physiatry Pain Management, P.a | Specialist | 999 Mar Walt Dr, Fort Walton Beach, FL 32547-6758 | 2006-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255944955 | Theresa Ann Morvay | Behavior Technician | 419 Racetrack Rd Ne, Fort Walton Beach, FL 32547 | 2020-08-24 |
| 1588295422 | Emily Ann Glossop | Nurse Practitioner | 930 Mar Walt Drive C, Fort Walton Beach, FL 32547 | 2020-01-29 |
| 1225669443 | Elizabeth Rogers Nagengast | Physician Assistant | 930 Mar Walt Drive, Unit C, Fort Walton Beach, FL 32547 | 2020-01-27 |
| 1497254791 | Carmen Alston | Nurse Practitioner | 930 Mar Walt Dr C, Fort Walton Beach, FL 32547 | 2018-02-02 |
| 1871004960 | Center for Neuropsychological Services Cns | Clinical Neuropsychologist | 1817 Lewis Turner Blvd, Fort Walton Beach, FL 32547 | 2017-10-17 |
| 1194235648 | Robin Wray | Speech-Language Pathologist | 930 Mar Walt Dr D, Fort Walton Beach, FL 32547 | 2017-10-10 |
| 1285007989 | Dynamic Pain & Wellness Pllc | Pain Medicine | 930 Marwalt Drive, Suite B and C, Fort Walton Beach, FL 32547 | 2015-11-04 |
| 1013392810 | Terry Abbott | Social Worker | 648 Overbrook Dr, Fort Walton Beach, FL 32547 | 2015-07-22 |
| 1083024673 | Emily Lohr | Physical Therapy Assistant | 2000 Principle Ln, Ft. Walton Beach, FL 32547 | 2014-05-05 |
| 1831526102 | Laurie Ann Schweppe | Nurse Practitioner | 1005 Mar Walt Drivve, Snf Hospitalist Department, Fort Walton Beach, FL 32547 | 2013-10-02 |
| Find all providers in zip 32547 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467437616 | David W Burkland | Surgery | 999 Mar Walt Drive, White-wilson East Building, Fort Walton Beach, FL 32547-6707 | 2005-12-09 |
| 1609872688 | John Robert Brent | Surgery | 1032 Mar Walt Dr, Ste 220, Fort Walton Beach, FL 32547-6645 | 2005-06-23 |
| 1518338565 | Advanced Vascular Care Inc | Surgery | 2010 Lewis Turner Blvd, Fort Walton Beach, FL 32547-1352 | 2015-10-16 |
| 1659770311 | Tara Harden M.d., P.a. | Surgery | 1775 Lewis Turner Blvd, Suite 101, Fort Walton Beach, FL 32547-1267 | 2014-08-19 |
| 1063852192 | Emilio Claudio Calabrese | Surgery | 2010 Lewis Turner Blvd, Fort Walton Beach, FL 32547 | 2013-07-03 |
| 1174677124 | Patrick Thomas Mcgraw | Surgery | 1703 Lewis Turner Blvd, Fort Walton Beach, FL 32547-1221 | 2007-01-23 |
| 1902839798 | Mauri G Lunderman, M.d., P.a. | Surgery | 1775 Lewis Turner Blvd, Suite 102, Fort Walton Beach, FL 32547-1221 | 2006-07-08 |
| 1023083177 | John Christofer Dali | Surgery | 999 Mar Walt Drive, White-wilson East Building, Fort Walton Beach, FL 32547-6707 | 2006-02-22 |
| 1073598983 | Robert Lane Rogers | Surgery | 999 Mar Walt Drive, White-wilson East Building, Fort Walton Beach, FL 32547 | 2005-12-13 |
| 1346222122 | Michael William Restey | Surgery | 1000 Mar Walt Dr, Fort Walton Beach, FL 32547-6708 | 2005-11-16 |
| Find all providers in FORT WALTON BEACH | ||||
| City | FORT WALTON BEACH |
| Zip Code | 32547 |
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| 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.