MEDICARE: BAYSIDE SURGICAL ASSOCIATES

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1841305398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYSIDE SURGICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	2933 MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4411
Country	:	US
Telephone Number	:	850-913-6958
Fax Number	:	850-913-6959

Provider Business Practice Location Address
First Line	:	2933 MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4411
Country	:	US
Telephone Number	:	850-913-6958
Fax Number	:	850-913-6959

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SHIREEN S RAHMAN
Credential	:
Telephone Number	:	850-276-1328

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/22/2020

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Directions to “BAYSIDE SURGICAL ASSOCIATES ” Practice Location

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