Healthcare Provider Details

I. General information

NPI: 1447681804
Provider Name (Legal Business Name): HOUSE CALL PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 W BALDWIN RD STE B
PANAMA CITY FL
32405-3359
US

IV. Provider business mailing address

625 W BALDWIN RD STE B
PANAMA CITY FL
32405-3359
US

V. Phone/Fax

Practice location:
  • Phone: 850-628-9240
  • Fax: 850-522-5925
Mailing address:
  • Phone: 850-628-9240
  • Fax: 850-522-5925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RUBINA AZAM
Title or Position: OWNER
Credential: MD
Phone: 850-628-9240