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NPI Code Detail

MEDICARE: DREAM MEDICAL, LLC

MEDICARE: DREAM MEDICAL, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistME89523FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518246560
Entity Type Code : Organization
Provider Name (Legal Business Name) : DREAM MEDICAL, LLC
Provider Business Mailing Address
First Line : 2103 JENKS AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4511
Country : US
Telephone Number : 850-763-8000
Fax Number : 850-785-1122
Provider Business Practice Location Address
First Line : 2103 JENKS AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4511
Country : US
Telephone Number : 850-763-8000
Fax Number : 850-785-1122
Authorized Official
Title or Position : PRESIDENT
Name : AARON J SHORES
Credential : M.D.
Telephone Number : 850-763-8000
Provider Enumeration Date : 08/09/2011
Last Update Date : 08/28/2012

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Directions to “DREAM MEDICAL, LLC ” Practice Location

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