Unknown Individual – General Practice Physician, NPI 1033177662

Unknown Individual is a healthcare provider. based in Gulf breeze, Florida. specializing in General Practice Physician. They hold a License No. OS3562 (FL). The NPI Number for Unknown Individual is 1033177662

Main info

Organization
Inactive
53 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1033177662
Phone
(850) 934-3920
Address
105 BAY BRIDGE DR
Deactivation Date
10 July 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3527752180
Graduation Year
1973 (53 years ago)
PAC ID
1254349889
Group Practice PAC ID
6406167733
Professional Enrollment ID
I20060323000540
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Bay Bridge Drive, Gulf Breeze, Santa Rosa County, Florida, 32561, United States

    GULF BREEZE, FL 325614470

    Phone: (850) 934-3920

    Fax: (850) 934-3922

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 32561)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6406167733View full group profile
NameSpecialtyState
C H I R O P R A C T I CFL
-FL
Nurse PractitionerFL
Physical Therapist In Private PracticeFL

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1033177662.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with General Practice Physician. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Gulf Breeze, Florida; more addresses can appear in NPPES.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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