Unknown Individual – Orthopaedic Surgery Physician, NPI 1417990995

Unknown Individual is a healthcare provider. based in Panama city, Florida. specializing in Orthopaedic Surgery Physician. They hold a License No. 16213 (AL). The NPI Number for Unknown Individual is 1417990995

Main info

Organization
Inactive
45 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1417990995
Phone
(850) 769-1511
Address
601 NORTH BONITA AVENUE BAY MEDICAL CENTER
Deactivation Date
13 December 2022

Doctor Profile

Medical School Name
UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE
Secondary Phone
8507476591
Graduation Year
1981 (45 years ago)
PAC ID
2466404736
Group Practice PAC ID
5991604852
Professional Enrollment ID
I20190522001671
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:0State licenses:2Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 601 NORTH BONITA AVENUE BAY MEDICAL CENTER

    PANAMA CITY, FL 324013409

    Phone: (850) 769-1511

    Type: Mailing

  • 1515 6th Ave S

    Birmingham, AL 352331601

    Phone: (205) 279-2860

    Fax: (205) 252-0197

    Type: Location

  • 601 North Bonita Avenue Bay Medical Center

    Panama City, FL 32401

    Phone: (850) 769-1511

    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.

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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 32401)

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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: 5991604852View full group profile
NameSpecialtyState
Orthopedic SurgeryFL
General SurgeryFL
Emergency MedicineFL
-FL
Vascular Surgery, General SurgeryFL
-FL
Cardiac Surgery, Thoracic Surgery, Cardiovascular Disease (Cardiology)FL
Internal MedicineFL
General SurgeryFL
-FL

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1417990995.
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 Orthopaedic Surgery Physician. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Panama City, Florida in registry-derived data.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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