Healthcare Provider Details

I. General information

NPI: 1912967142
Provider Name (Legal Business Name): MUSTAFA A HAMMAD M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 MARTIN LUTHER KING JR BLVD
PANAMA CITY FL
32405-5314
US

IV. Provider business mailing address

1931 MARTIN LUTHER KING JR BLVD
PANAMA CITY FL
32405-5314
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 TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberME93997
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME93997
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME93997
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberME93997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: