MEDICARE: ASTHMA AND ALLERGY CLINIC, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207KA0200X	Allergy Physician
2	207R00000X	Internal Medicine Physician
3	207RA0201X	Allergy & Immunology (Internal Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093812612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASTHMA AND ALLERGY CLINIC, P.A.

Provider Business Mailing Address
First Line	:	2687 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4351
Country	:	US
Telephone Number	:	850-747-3665
Fax Number	:

Provider Business Practice Location Address
First Line	:	2687 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4351
Country	:	US
Telephone Number	:	850-747-3665
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GEETA KHARE
Credential	:	M.D.
Telephone Number	:	850-747-3665

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	11/05/2012

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