Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 706D | FL |
Y | 208D00000X | General Practice Physician | 706D | FL |
NPI | 1023295821 |
---|---|
Provider Name | Dr. Gerald M Hollingsworth |
First Address | Fort Walton Beach, FL 32547-1496 |
Second Address | Fort Walton Beach, FL 32547-1496 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2008 |
Last Update Date | 24/01/2008 |