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General NPI Number Information
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NPI Number | 1457357006
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Entity Type | Individual
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Provider Name | MARIUSZ JERZY KLIN MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 2202 STATE AVE SUITE 301
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City | PANAMA CITY
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State | FL
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Zip | 32405-7601
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Country | US
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Telephone | 850-215-7071
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Fax | 850-215-7073
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Provider Business Mailing Address
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Address Line | PO BOX 452
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City | LYNN HAVEN
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State | FL
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Zip | 32444-0452
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Country | US
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Telephone | 850-215-7071
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Fax | 850-215-7073
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME85851
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | A63234
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License Number State | CA
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