Healthcare Provider Details

I. General information

NPI: 1740744663
Provider Name (Legal Business Name): SAOL MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 JENKS AVE
PANAMA CITY FL
32405-4224
US

IV. Provider business mailing address

9860 S THOMAS DR UNIT 1809
PANAMA CITY FL
32408-1285
US

V. Phone/Fax

Practice location:
  • Phone: 516-244-1857
  • Fax:
Mailing address:
  • Phone: 516-244-1857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEAN EDSON BELCOURT
Title or Position: MD
Credential:
Phone: 516-244-1857