Healthcare Provider Details

I. General information

NPI: 1093812612
Provider Name (Legal Business Name): ASTHMA AND ALLERGY CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2687 JENKS AVE
PANAMA CITY FL
32405-4351
US

IV. Provider business mailing address

2687 JENKS AVE
PANAMA CITY FL
32405-4351
US

V. Phone/Fax

Practice location:
  • Phone: 850-747-3665
  • Fax:
Mailing address:
  • Phone: 850-747-3665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: GEETA KHARE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 850-747-3665