Healthcare Provider Details

I. General information

NPI: 1235150863
Provider Name (Legal Business Name): PANAMA CITY PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1937 HARRISON AVE
PANAMA CITY FL
32405-4543
US

IV. Provider business mailing address

PO BOX 15697
PANAMA CITY FL
32406-5697
US

V. Phone/Fax

Practice location:
  • Phone: 850-747-3048
  • Fax: 850-747-0194
Mailing address:
  • Phone: 850-747-3048
  • Fax: 850-747-0194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME91470
License Number StateFL

VIII. Authorized Official

Name: DR. EEHAB A KENAWY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 850-747-3661