Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | ME 91174 | FL |
NPI | 1225020936 |
---|---|
Provider Name | Dr. Joshua Gilman Hackel |
First Address | Gulf Breeze, FL 32561-7808 |
Second Address | Gulf Breeze, FL 32561-7809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 24/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110611 | (05) | AL |
273585700 | (05) | FL |
50284 | BLUE CROSS BLUE SHIELD (01) | FL |
591-82235 | BLUE CROSS BLUE SHIELD (01) | AL |
H94544 | (02) |