Healthcare Provider Details

I. General information

NPI: 1427501444
Provider Name (Legal Business Name): YAHIA RAHIM-ABDUL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 19TH ST
PANAMA CITY FL
32405-4628
US

IV. Provider business mailing address

200 W 19TH ST
PANAMA CITY FL
32405-4628
US

V. Phone/Fax

Practice location:
  • Phone: 850-872-0021
  • Fax: 850-872-8088
Mailing address:
  • Phone: 850-872-0021
  • Fax: 850-872-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: YAHIA A RAHIM
Title or Position: OWNER
Credential: M.D.
Phone: 850-872-0021