MEDICARE: BRIGHT PEDIATRICS

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	261QP2300X	Primary Care Clinic/Center	ME111081	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	:	1306202197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT PEDIATRICS

Provider Business Mailing Address
First Line	:	340 W 23RD ST
Second Line	:	SUITE B
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-7600
Country	:	US
Telephone Number	:	850-257-5147
Fax Number	:	850-257-5886

Provider Business Practice Location Address
First Line	:	3520 E 15TH ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32404-5831
Country	:	US
Telephone Number	:	850-763-4104
Fax Number	:	850-763-6689

Authorized Official
Title or Position	:	MD
Name	:	SAMEH M ELAMIR X
Credential	:	MD
Telephone Number	:	850-257-5147

Provider Enumeration Date	:	01/08/2016
Last Update Date	:	01/08/2016

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Directions to “BRIGHT PEDIATRICS ” Practice Location

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