| White-wilson Association, P.a. | |
|
999 Mar Walt Dr Fort Walton Beach FL 32547-6758 | |
| (850) 863-8150 | |
| (850) 863-4152 |
| Full Name | White-wilson Association, P.a. |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 999 Mar Walt Dr, Fort Walton Beach, Florida |
| Authorized Official Name and Position | Alan L Gieseman (CEO) |
| Authorized Official Contact | 8508638150 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| White-wilson Association, P.a. 1005 Mar Walt Dr Fort Walton Beach FL 32547-6707 Ph: (850) 863-8150 | White-wilson Association, P.a. 999 Mar Walt Dr Fort Walton Beach FL 32547-6758 Ph: (850) 863-8150 |
| NPI Number | 1831846336 |
|---|---|
| Provider Enumeration Date | 03/04/2022 |
| Last Update Date | 03/04/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831846336 | NPI | - | NPPES |
| 99017 | Other | FL | FLORIDA BLUE |
| 059722800 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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