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General NPI Number Information
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NPI Number | 1831262229
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Entity Type | Organization
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Legal Business Name | GULF COAST MEDICAL AND GERIATRIC CLINIC INC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 237 E BALDWIN RD STE 102
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City | PANAMA CITY
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State | FL
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Zip | 32405-4463
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Country | US
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Telephone | 850-522-0182
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Fax | 850-522-0184
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Provider Business Mailing Address
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Address Line | PO BOX 1317
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City | LYNN HAVEN
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State | FL
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Zip | 32444-6117
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Country | US
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Telephone | 850-522-0182
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Fax | 850-522-0184
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Authorized Official
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Title or Position | DIRECTOR
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Name | LIAQAT HAYAT
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Credential | MD
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Telephone | 850-522-0182
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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 | ME83788
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License Number State | FL
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