Healthcare Provider Details

I. General information

NPI: 1659331767
Provider Name (Legal Business Name): KAMEL ELZAWAHRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 STATE AVE STE 201
PANAMA CITY FL
32405-4582
US

IV. Provider business mailing address

2202 STATE AVE SUITE 201
PANAMA CITY FL
32405-7601
US

V. Phone/Fax

Practice location:
  • Phone: 850-785-0029
  • Fax: 850-785-7600
Mailing address:
  • Phone: 850-785-0029
  • Fax: 850-785-7600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberMR36616
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME36616
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: