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General NPI Number Information
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NPI Number | 1205844396
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Entity Type | Organization
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Legal Business Name | MUTAZ A. TABBAA, M.D., P.A.
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 2559 HUNTCLIFF LN
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City | PANAMA CITY
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State | FL
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Zip | 32405-4902
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Country | US
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Telephone | 850-763-0333
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Fax | 850-763-1477
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Provider Business Mailing Address
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Address Line | 2559 HUNTCLIFF LN
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City | PANAMA CITY
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State | FL
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Zip | 32405-4902
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Country | US
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Telephone | 850-763-0333
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Fax | 850-763-1477
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MUTAZ A. TABBAA
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Credential | M.D.
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Telephone | 850-763-0333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME48669
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License Number State | FL
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