Healthcare Provider Details

I. General information

NPI: 1669565974
Provider Name (Legal Business Name): DHVANIT K VIJAPURA MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 WILSON AVE
PANAMA CITY FL
32405-4532
US

IV. Provider business mailing address

2003 WILSON AVE
PANAMA CITY FL
32405-4532
US

V. Phone/Fax

Practice location:
  • Phone: 850-784-9991
  • Fax: 850-763-8361
Mailing address:
  • Phone: 850-784-9991
  • Fax: 850-763-8361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME59359
License Number StateFL

VIII. Authorized Official

Name: AMY N STREICHERT
Title or Position: PRACTICE ADM
Credential:
Phone: 850-784-9991