Healthcare Provider Details

I. General information

NPI: 1861606394
Provider Name (Legal Business Name): HASAN EBEID
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 STATE AVE SUITE 302
PANAMA CITY FL
32405-7601
US

IV. Provider business mailing address

2202 STATE AVE SUITE 302
PANAMA CITY FL
32405-7601
US

V. Phone/Fax

Practice location:
  • Phone: 850-785-0321
  • Fax: 850-784-9955
Mailing address:
  • Phone: 850-785-0321
  • Fax: 850-784-9955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME111582
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: