MEDICARE: DR. GHOSN A ISSA MD

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	207R00000X	Internal Medicine Physician	ME71909	FL
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME71909	FL

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	:	1215975198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GHOSN A ISSA MD

Provider Business Mailing Address
First Line	:	PO BOX 2699
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32513-2699
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5149 N 9TH AVE
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32504-8756
Country	:	US
Telephone Number	:	850-416-2340
Fax Number	:	850-416-2338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	06/25/2010

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Directions to “ DR. GHOSN A ISSA MD” Practice Location

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