Healthcare Provider Details

I. General information

NPI: 1841615317
Provider Name (Legal Business Name): FERNANDO GONZALEZ IBARRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 W 23RD ST
PANAMA CITY FL
32405-4507
US

IV. Provider business mailing address

809 PADDOCK CLUB DR
PANAMA CITY BEACH FL
32407-2404
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-8341
  • Fax:
Mailing address:
  • Phone: 201-245-5770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME125873
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: