Healthcare Provider Details

I. General information

NPI: 1932477023
Provider Name (Legal Business Name): SAMIR M. EBEID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 STATE AVE STE 302
PANAMA CITY FL
32405
US

IV. Provider business mailing address

2202 STATE AVE STE 302
PANAMA CITY FL
32405
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 NumberME0046120
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberME0046120
License Number StateFL

VIII. Authorized Official

Name: MR. SAMIR MASAN EBEID
Title or Position: PRESIDENT
Credential: MD
Phone: 850-785-0321