SCULPSIT PLASTIC SURGERY PA
Medical Practice at Gulf Breeze Pkwy, Gulf Breeze, FL

License number
Florida ME102994
Category
Medical Practice
Type
Plastic Surgery
Owner
Name: SEAN WOLFORT MD
Title: PHYSICIAN/OWNER
Phone: (800) 477-7458
Address
Address
1118 Gulf Breeze Pkwy SUITE 200, Gulf Breeze, FL 32561
National Provider ID: 1154573384
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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SCULPSIT PLASTIC SURGERY,P.A

1118 Gulf Breeze Pkwy SUITE 200, Gulf Breeze, FL 32561

Status:
Inactive
Industry:
Medical Doctor's Office
Inactive reason:
VOLUNTARY DISSOLUTION
Registration:
Sep 26, 2008
Inactive since:
Feb 24, 2010
State ID:
P08000088456
Business type:
Florida Profit Corporation
CEO, Chairman:
Sean F Wolfort CEO, Chairman, inactive, 1118 Gulf Breeze Pkwy, Gulf Breeze, FL 32561 (Physical)
Agent:
Walker, Gary,202 S Rome Ave SUITE 100, Tampa, FL 33606 (Physical)
EIN:
26-3502038

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