MEDICARE: PATRICK MARWAN TAMIM 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	2086S0129X	Vascular Surgery Physician	ME98003	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	93784	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1548392475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK MARWAN TAMIM M.D.

Provider Business Mailing Address
First Line	:	221 E 23RD ST
Second Line	:	SUITE E
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-7612
Country	:	US
Telephone Number	:	850-215-9654
Fax Number	:	850-215-6934

Provider Business Practice Location Address
First Line	:	221 E 23RD ST
Second Line	:	SUITE E
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-7612
Country	:	US
Telephone Number	:	850-215-9654
Fax Number	:	850-215-6934

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	12/10/2019

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