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General NPI Number Information
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NPI Number | 1659332278
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Entity Type | Individual
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Provider Name | AYMAN TAHA ABOULELA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 05/02/2014
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Provider Practice Location Address
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Address Line | 109 W 23RD N-5
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City | PANAMA CITY
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State | FL
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Zip | 32405
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Country | US
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Telephone | 850-769-1566
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Fax | 850-769-1644
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Provider Business Mailing Address
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Address Line | P.O. 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 | 850-769-1566
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Fax | 850-769-1644
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME90177
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License Number State | FL
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