MEDICARE: DR. EDWARD A PANACEK MD

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	207P00000X	Emergency Medicine Physician	G47762	CA
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	34093	AL
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	G47762	CA
4	207P00000X	Emergency Medicine Physician	34093	AL

Other Identifiers

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

General Provider Information

NPI Number	:	1871577049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD A PANACEK MD

Provider Business Mailing Address
First Line	:	PO BOX 40010
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36640-0010
Country	:	US
Telephone Number	:	251-471-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2451 UNIVERSITY HOSPITAL DR
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36617-2300
Country	:	US
Telephone Number	:	251-471-7000
Fax Number	:	251-471-7096

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	03/02/2021

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Directions to “ DR. EDWARD A PANACEK MD” Practice Location

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