Healthcare Provider Details

I. General information

NPI: 1124134093
Provider Name (Legal Business Name): KEVIN EDWARD ROHAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N RICHARD JACKSON BLVD STE 140
PANAMA CITY BEACH FL
32407-2522
US

IV. Provider business mailing address

120 N RICHARD JACKSON BLVD STE 140
PANAMA CITY BEACH FL
32407-2522
US

V. Phone/Fax

Practice location:
  • Phone: 850-532-6168
  • Fax: 850-532-6568
Mailing address:
  • Phone: 850-532-6168
  • Fax: 850-532-6568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9103876
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: