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General NPI Number Information
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NPI Number | 1841305398
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Entity Type | Organization
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Legal Business Name | BAYSIDE SURGICAL ASSOCIATES
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2933 MARTIN LUTHER KING JR BLVD
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City | PANAMA CITY
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State | FL
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Zip | 32405-4411
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Country | US
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Telephone | 850-913-6958
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Fax | 850-913-6959
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Provider Business Mailing Address
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Address Line | 2933 MARTIN LUTHER KING JR BLVD
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City | PANAMA CITY
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State | FL
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Zip | 32405-4411
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Country | US
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Telephone | 850-913-6958
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Fax | 850-913-6959
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SHIREEN S RAHMAN
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Credential |
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Telephone | 850-276-1328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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