Healthcare Provider Details

I. General information

NPI: 1053871830
Provider Name (Legal Business Name): RAMI MUTAZ TABBAA DO, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 W BALDWIN RD
PANAMA CITY FL
32405-3364
US

IV. Provider business mailing address

621 W BALDWIN RD
PANAMA CITY FL
32405-3364
US

V. Phone/Fax

Practice location:
  • Phone: 850-747-3661
  • Fax: 850-747-0194
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS18567
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: