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Organization Active NPI

4MD2 Physician Services of Fort Walton Beach LLC

  • Emergency Medicine Physician
  • Fort Walton Beach, FL
National Provider Identifier
1568420735
Registry record updated Jul 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
4MD2 PHYSICIAN SERVICES OF FORT WALTON BEACH LLC
Practice address
1000 Mar Walt Dr
Fort Walton Beach, FL 32547-6708
Phone
(850) 863-7607
Fax
(205) 437-5998
NPI assigned
May 3, 2006
Last updated
Jul 20, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2007

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

Authorized official

Name
Mr. Guy Duwane Hooper
Title
President
Phone
(205) 437-6098

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X FL Primary

Addresses

Primary practice location

1000 Mar Walt Dr
Fort Walton Beach, FL 32547-6708

Mailing address

PO Box 88452
Chicago, IL 60680-1452
Phone (205) 437-6098

Other identifiers 5

IdentifierTypeStateIssuer
7800781OtherFLAETNA GROUP PROVIDER NO
97859OtherFLBCBS GROUP NUMBER
DE2947OtherFLRRMC GROUP NUMBER
2622096OtherFLUNITEDHEALTHCARE OF FL
F938OtherALBCBS GROUP PROVIDER NO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 32

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.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184889600000",
    "number": "1568420735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 88452",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606801452",
            "telephone_number": "205-437-6098",
            "fax_number": "205-437-5998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476708",
            "telephone_number": "850-863-7607",
            "fax_number": "205-437-5998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "4MD2 PHYSICIAN SERVICES OF FORT WALTON BEACH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2007-07-20",
        "status": "A",
        "authorized_official_last_name": "HOOPER",
        "authorized_official_first_name": "GUY",
        "authorized_official_middle_name": "DUWANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "205-437-6098",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA GROUP PROVIDER NO",
            "identifier": "7800781",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "97859",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC GROUP NUMBER",
            "identifier": "DE2947",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITEDHEALTHCARE OF FL",
            "identifier": "2622096",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP PROVIDER NO",
            "identifier": "F938",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.