Healthcare Provider Details

I. General information

NPI: 1063602258
Provider Name (Legal Business Name): MUSTAFA A HAMMAD MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 MARTIN LUTHER KING JR BLVD
PANAMA CITY FL
32405-4704
US

IV. Provider business mailing address

1931 MARTIN LUTHER KING JR BLVD
PANAMA CITY FL
32405-4704
US

V. Phone/Fax

Practice location:
  • Phone: 850-215-7093
  • Fax: 850-215-7096
Mailing address:
  • Phone: 850-215-7093
  • Fax: 850-215-7096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MUSTAFA HAMMAD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 850-215-7093