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General NPI Number Information
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NPI Number | 1609968429
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Entity Type | Organization
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Legal Business Name | AYMAN T ABOULELA MD PA
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 2202 STATE AVE SUITE 102
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City | PANAMA CITY
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State | FL
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Zip | 32405-4539
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Country | US
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Telephone | 850-785-0085
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Fax | 850-785-0558
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Provider Business Mailing Address
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Address Line | PO BOX 15834
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City | PANAMA CITY
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State | FL
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Zip | 32406
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Country | US
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Telephone | 850-785-0085
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Fax | 850-785-0558
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AYMAN T ABOULELA
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Credential | M.D.
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Telephone | 850-785-0085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME90177
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License Number State | FL
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