| Entity Name: | PROFESSIONAL PARK PEDIATRICS, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 19 Feb 1999 (26 years ago) |
| Document Number: | P99000016386 |
| FEI/EIN Number | 593557024 |
| Address: | 1881 PROFESSIONAL PARK CIRCLE, SUITE 80, TALLAHASSEE, FL, 32308 |
| Mail Address: | 1881 PROFESSIONAL PARK CIRCLE, SUITE 80, TALLAHASSEE, FL, 32308 |
| ZIP code: | 32308 |
| County: | Leon |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841289204 | 2005-10-18 | 2009-09-09 | 1881 PROFESSIONAL PARK CIR, SUITE 80, TALLAHASSEE, FL, 323084541, US | 1881 PROFESSIONAL PARK CIR, SUITE 80, TALLAHASSEE, FL, 323084541, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-402-5454 |
| Fax | 8504025451 |
Authorized person
| Name | DR. WALTER G. BUNNELL III |
| Role | PRESIDENT |
| Phone | 8504025454 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME37597 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME75773 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME82183 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME91797 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| BUNNELL WALTER G | Agent | 1881 PROFESSIONAL PARK CIRCLE, SUITE 80, TALLAHASSEE, FL, 32308 |
| Name | Role | Address |
|---|---|---|
| BUNNELL WALTER GIII | President | 1881 PROFESSIONAL PARK CIRCLE, SUITE 80, TALLAHASSEE, FL, 32308 |
| Name | Role | Address |
|---|---|---|
| BUNNELL WALTER GIII | Director | 1881 PROFESSIONAL PARK CIRCLE, SUITE 80, TALLAHASSEE, FL, 32308 |
| ELZIE JOHN L | Director | 1881 PROFESSIONAL PARK CIRCLE, SUITE 80, TALLAHASSEE, FL, 32308 |
| MARTIN JAMES E | Director | 1881 PROFESSIONAL PARK CIRCLE, SUITE 80, TALLAHASSEE, FL, 32308 |
| Name | Role | Address |
|---|---|---|
| ELZIE JOHN L | Secretary | 1881 PROFESSIONAL PARK CIRCLE, SUITE 80, TALLAHASSEE, FL, 32308 |
| Name | Role | Address |
|---|---|---|
| MARTIN JAMES E | Treasurer | 1881 PROFESSIONAL PARK CIRCLE, SUITE 80, TALLAHASSEE, FL, 32308 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-19 |
| ANNUAL REPORT | 2023-02-12 |
| ANNUAL REPORT | 2022-03-15 |
| ANNUAL REPORT | 2021-04-05 |
| ANNUAL REPORT | 2020-04-08 |
| ANNUAL REPORT | 2019-02-25 |
| ANNUAL REPORT | 2018-01-14 |
| ANNUAL REPORT | 2017-01-06 |
| ANNUAL REPORT | 2016-03-08 |
| ANNUAL REPORT | 2015-02-19 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
