MEDICARE: AZZAM ADHAL, M.D.

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
1	207R00000X	Internal Medicine Physician	ME39621	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1295714129	OTHER	FL	INDIVIDUAL NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518360288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZZAM ADHAL, M.D.

Provider Business Mailing Address
First Line	:	PO BOX 15909
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32406-5909
Country	:	US
Telephone Number	:	850-784-6696
Fax Number	:	850-785-2100

Provider Business Practice Location Address
First Line	:	2195 JENKS AVE STE B
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4683
Country	:	US
Telephone Number	:	850-784-6696
Fax Number	:	850-785-2100

Authorized Official
Title or Position	:	OWNER
Name	:	AZZAM ADHAL
Credential	:	MD
Telephone Number	:	850-784-6696

Provider Enumeration Date	:	10/08/2014
Last Update Date	:	11/15/2022

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