Healthcare Provider Details

I. General information

NPI: 1497022685
Provider Name (Legal Business Name): BRIGHT PEDIATRICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 E 15TH ST
PANAMA CITY FL
32404-5831
US

IV. Provider business mailing address

PO. BOX 1491
LYNN HAVEN FL
32444-5431
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-4104
  • Fax: 850-763-6689
Mailing address:
  • Phone: 850-763-4104
  • Fax: 850-763-6689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME111081
License Number StateFL

VIII. Authorized Official

Name: SAMEH MOHAMED ELAMIR
Title or Position: PRESIDENT
Credential: MD
Phone: 850-763-4104