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General NPI Number Information
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NPI Number | 1659813053
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Entity Type | Organization
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Legal Business Name | BREAKFAST POINT PEDIATRICS INC
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 12/29/2017
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Provider Practice Location Address
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Address Line | 10800 PANAMA CITY BEACH PKWY STE 400
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-2532
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Country | US
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Telephone | 850-249-3500
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Fax | 850-249-3530
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Provider Business Mailing Address
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Address Line | PO BOX 578
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City | LYNN HAVEN
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State | FL
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Zip | 32444-0578
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Country | US
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Telephone | 850-249-3500
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Fax | 850-249-3530
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Authorized Official
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Title or Position | OWNER
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Name | DR. AHMED REZK
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Credential | M.D.
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Telephone | 973-356-6245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME10552
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License Number State | FL
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