Healthcare Provider Details

I. General information

NPI: 1659813053
Provider Name (Legal Business Name): BREAKFAST POINT PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 12/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 PANAMA CITY BEACH PKWY STE 400
PANAMA CITY BEACH FL
32407-2532
US

IV. Provider business mailing address

PO BOX 578
LYNN HAVEN FL
32444-0578
US

V. Phone/Fax

Practice location:
  • Phone: 850-249-3500
  • Fax: 850-249-3530
Mailing address:
  • Phone: 850-249-3500
  • Fax: 850-249-3530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME10552
License Number StateFL

VIII. Authorized Official

Name: DR. AHMED REZK
Title or Position: OWNER
Credential: M.D.
Phone: 973-356-6245