Candace Sue Cooley, M D
Individual provider Active NPI Obstetrics & Gynecology Physician · Fort Walton Beach, FL
NPI 1104860089 · NPPES record last updated Jun 26, 2015
Key facts
- NPI
- 1104860089
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- ME77965 (FL)
- Practice address
- 11 Racetrack Rd NE
Suite D-2
Fort Walton Beach, FL 32547-1882 - Phone
- (850) 586-7661
- Fax
- (850) 586-7679
- NPI assigned
- Jun 15, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 47511 | CO | MD | Obstetrics & Gynecology Physician |
| ME77965 | FL | MD | Obstetrics & Gynecology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | ME77965 | FL | Yes |
| Obstetrics & Gynecology Physician | 207V00000X | 47511 | CO |
Addresses
Primary practice location
11 Racetrack Rd NE
Suite D-2
Fort Walton Beach, FL 32547-1882
Mailing address
11 Racetrack Rd NE
Suite D-2
Fort Walton Beach, FL 32547-1882
Phone (850) 586-7661
Other providers in Fort Walton Beach, FL
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- Melodie Lynn Conti
- Brandon Wade Cook
- Darren L. Cook
- Michayla Cook
- Sally A. Cooper
- Yvonne Cooper
- Sydney Ilana Cope
- Crystal Gillette Copeland
- David I Copeland
All providers in Fort Walton Beach, FL · Obstetrics & Gynecology Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 26, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.