MEDICARE: DR. AZZAM A ADHAL 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	ME39261	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
2	0080N	OTHER	FL	FLORIDA BLUE
3	1518360288	OTHER	FL	FLORIDA BLUE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295714129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AZZAM A ADHAL MD

Provider Business Mailing Address
First Line	:	PO BOX 15909
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32406-5909
Country	:	US
Telephone Number	:	850-784-6696
Fax Number	:	850-785-2100

Provider Business Practice Location Address
First Line	:	2195 JENKS AVE
Second Line	:	STE B
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4551
Country	:	US
Telephone Number	:	850-784-6696
Fax Number	:	850-785-2100

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	11/15/2022

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