Healthcare Provider Details

I. General information

NPI: 1326159310
Provider Name (Legal Business Name): THE CLINIC OF PEDIATRICS & GI MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 MEDICAL CENTER DR
PANAMA CITY FL
32405-4907
US

IV. Provider business mailing address

102 MEDICAL CENTER DR
PANAMA CITY FL
32405-4907
US

V. Phone/Fax

Practice location:
  • Phone: 850-913-1666
  • Fax: 850-913-1549
Mailing address:
  • Phone: 850-913-1666
  • Fax: 850-913-1549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMED M ZEINOMAR
Title or Position: PRESIDENT
Credential: MD
Phone: 850-913-1666