Healthcare Provider Details

I. General information

NPI: 1447745393
Provider Name (Legal Business Name): MORVARID ZANDIYEH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2018
Last Update Date: 02/24/2023
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

200 GRAND PANAMA CIR APT 310
PANAMA CITY BEACH FL
32407-3476
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-8341
  • Fax:
Mailing address:
  • Phone: 949-272-6628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME155803
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: