1780673467 NPI number — MR. FREDDIE EUGENE THRONSON JR. ARNP

Table of content: MR. FREDDIE EUGENE THRONSON JR. ARNP (NPI 1780673467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780673467 NPI number — MR. FREDDIE EUGENE THRONSON JR. ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THRONSON
Provider First Name:
FREDDIE
Provider Middle Name:
EUGENE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
ARNP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780673467
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6000 W HIGHWAY 98
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32512-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-505-6601
Provider Business Mailing Address Fax Number:
850-505-6608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6000 W HIGHWAY 98 NAVY HOSPITAL FAMILY MED GOLD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32512-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-505-6601
Provider Business Practice Location Address Fax Number:
850-505-6608
Provider Enumeration Date:
10/17/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  2635022 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)