MEDICARE: MUTAZ A. TABBAA, M.D., P.A.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME48669	FL

General Provider Information

NPI Number	:	1205844396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUTAZ A. TABBAA, M.D., P.A.

Provider Business Mailing Address
First Line	:	2559 HUNTCLIFF LN
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4902
Country	:	US
Telephone Number	:	850-763-0333
Fax Number	:	850-763-1477

Provider Business Practice Location Address
First Line	:	2559 HUNTCLIFF LN
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4902
Country	:	US
Telephone Number	:	850-763-0333
Fax Number	:	850-763-1477

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MUTAZ A. TABBAA
Credential	:	M.D.
Telephone Number	:	850-763-0333

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	08/08/2007

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