MEDICARE: CENTRE FOR INTEGRATIVE AND HOLISTIC MEDICINE

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	207Q00000X	Family Medicine Physician
2	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1295230258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRE FOR INTEGRATIVE AND HOLISTIC MEDICINE

Provider Business Mailing Address
First Line	:	528 W BALDWIN RD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-3313
Country	:	US
Telephone Number	:	850-819-4723
Fax Number	:	850-481-1976

Provider Business Practice Location Address
First Line	:	528 W BALDWIN RD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-3313
Country	:	US
Telephone Number	:	850-777-3250
Fax Number	:	850-522-5925

Authorized Official
Title or Position	:	OWNER
Name	:	RUBINA AZAM
Credential	:	MD
Telephone Number	:	850-819-4723

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	01/29/2024

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Directions to “CENTRE FOR INTEGRATIVE AND HOLISTIC MEDICINE ” Practice Location

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