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General NPI Number Information
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NPI Number | 1306202197
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Entity Type | Organization
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Legal Business Name | BRIGHT PEDIATRICS
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Dates
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Enumeration Date | 01/08/2016
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Last Update Date | 01/08/2016
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Provider Practice Location Address
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Address Line | 3520 E 15TH ST
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City | PANAMA CITY
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State | FL
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Zip | 32404-5831
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Country | US
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Telephone | 850-763-4104
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Fax | 850-763-6689
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Provider Business Mailing Address
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Address Line | 340 W 23RD ST SUITE B
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City | PANAMA CITY
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State | FL
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Zip | 32405-7600
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Country | US
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Telephone | 850-257-5147
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Fax | 850-257-5886
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Authorized Official
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Title or Position | MD
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Name | SAMEH M ELAMIR X
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Credential | MD
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Telephone | 850-257-5147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME111081
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License Number State | FL
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