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General NPI Number Information
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NPI Number | 1508021684
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Entity Type | Organization
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Legal Business Name | MARIUSZ J KLIN M D P A
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Dates
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Enumeration Date | 07/28/2008
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Last Update Date | 07/23/2025
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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 | 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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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | STEPHNE ANN BLACKWELL
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Credential |
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Telephone | 850-215-7071
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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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