Healthcare Provider Details

I. General information

NPI: 1689874729
Provider Name (Legal Business Name): RICHARD A ADELMAN JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

738 HARRISON AVE
PANAMA CITY FL
32401-2524
US

IV. Provider business mailing address

738 HARRISON AVE
PANAMA CITY FL
32401-2524
US

V. Phone/Fax

Practice location:
  • Phone: 850-747-8346
  • Fax: 850-747-9649
Mailing address:
  • Phone: 850-747-8346
  • Fax: 850-747-9649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME43574
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberME43574
License Number StateFL

VIII. Authorized Official

Name: DR. RICHARD A ADELMAN JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 850-747-8346