Unknown Individual – Cardiovascular Disease Physician, NPI 1073562260

Unknown Individual is a healthcare provider. based in Panama city, Florida. specializing in Cardiovascular Disease Physician. They hold a License No. ME107042 (FL). The NPI Number for Unknown Individual is 1073562260

Main info

Organization
Inactive
45 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1073562260
Phone
(850) 913-8996
Address
2815 REDTAIL ST
Deactivation Date
1 March 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8502157117
Graduation Year
1981 (45 years ago)
PAC ID
2668467010
Group Practice PAC ID
3375726201
Professional Enrollment ID
I20110330000306
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 2815 REDTAIL ST

    PANAMA CITY, FL 324056687

    Phone: (850) 913-8996

    Fax: (850) 913-8956

    Type: Mailing

  • 2232, West 24th Street, Panama City, Bay County, Florida, 32405, United States

    PANAMA CITY, FL 324052226

    Phone: (850) 215-7117

    Fax: (850) 913-8956

    Type: Location

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 32405)

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Provider's Procedures

Unknown Individual performs procedures in Cardiovascular Disease Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
CARDIOVASCULAR DISEASE (CARDIOLOGY)FL78452Nuclear medicine study of vessels of heart using drugs or exercise multiple studies105104

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1073562260.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Cardiovascular Disease Physician. Clinical services aligned with this taxonomy classification.
Can patients visit Unknown Individual in Panama City, Florida?
For routing, start with Panama City, Florida for Unknown Individual, then verify phone and hours locally.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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