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General NPI Number Information
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NPI Number | 1144001074
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Entity Type | Organization
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Legal Business Name | FLORIDA MEDICAL LAB
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Dates
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Enumeration Date | 10/06/2023
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 631 W 23RD ST
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City | PANAMA CITY
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State | FL
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Zip | 32405-3922
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Country | US
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Telephone | 980-721-6622
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Fax |
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Provider Business Mailing Address
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Address Line | 631 W 23RD ST
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City | PANAMA CITY
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State | FL
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Zip | 32405-3922
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | OMAR IDLIBI
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Credential | MD
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Telephone | 980-721-6622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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