Crestview Neurology

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

CRESTVIEW NEUROLOGY

Practice address

535 S Ferdon Blvd
Suite C
Crestview, FL 32536-4446

Phone

(850) 423-4664

Fax

(850) 398-8824

NPI assigned

Sep 18, 2007

Last updated

Nov 19, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shijun PanNPI 1245280858

Title

Sole Owner

Phone

(850) 424-4664

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shijun Pan, M.D.

  • Specialist
  • Crestview, FL
  • NPI 1245280858
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763510400000",
    "number": "1194911768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 S FERDON BLVD STE C",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325364446",
            "telephone_number": "850-423-4664",
            "fax_number": "850-398-8824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 S FERDON BLVD",
            "address_2": "SUITE C",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325364446",
            "telephone_number": "850-423-4664",
            "fax_number": "850-398-8824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTVIEW NEUROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-18",
        "last_updated": "2025-11-19",
        "certification_date": "2025-11-19",
        "status": "A",
        "authorized_official_last_name": "PAN",
        "authorized_official_first_name": "SHIJUN",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "850-424-4664"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crestview Hospital Corporation (Gateway Medical Clinic)
• Crestview Hospital Corporation
• Crestview Immediate Care LLC
• Crestview Kids
• Crestview MRI (Center of Imaging Excellence Crestview)
• Crestview Open MRI Inc
• Crestview Open MRI Inc (Crestview Open MRI)
• Crestview Pediatrics and Adolescent Center PA
• Crestview Pharmacy, LLC
• Crestview Physical and Aquatic Therapy LLC

• Neurology Physician in Crestview, FL
• Providers in Crestview, FL by specialty
• Neurology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.