EMERALD COAST MOOD & MEMORY PA
Psychiatric at Mar Walt Dr, Fort Walton Beach, FL

License number
Florida ME 94223
Category
Psychiatric
Type
Psychiatry
Owner
Name: JAMES LOUIS IGLEBURGER MD
Title: PRESIDENT OWNER
Phone: (850) 226-4785
Address
Address
922 Mar Walt Dr SUITE 100, Fort Walton Beach, FL 32547
National Provider ID: 1710097704
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

See more information about EMERALD COAST MOOD & MEMORY PA at bizstanding.com

EMERALD COAST MOOD & MEMORY, PA

Fort Walton Beach, FL

Status:
Inactive
Industry:
Medical Doctor's Office, Whol Drugs/Sundries
Inactive reason:
VOLUNTARY DISSOLUTION
Registration:
Aug 7, 2006
Inactive since:
Sep 18, 2013
Addresses:
37 Chelsea Dr NW, Fort Walton Beach, FL 32547 (Physical)
922 Mar Walt Dr, Fort Walton Beach, FL 32547
State ID:
P06000103103
Business type:
Florida Profit Corporation
Director, Secretary, Presidents:
Md Igleburger, 922 Mar Walt Dr SUITE 100, Fort Walton Beach, FL 32547 (Physical),James L. Igleburger Director, Secretary, President, inactive
Agent:
Igleburger, James L, Md,922 Mar Walt Dr SUITE 100, Fort Walton Beach, FL 32547 (Physical)
EIN:
205352949

Psychiatric licenses in Florida










Other Doctors licenses in Florida