MEDICARE: DR. OSAMA ELSHAZLY M.D.

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	ME71008	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	32145	OTHER	FL	BCBS FLORIDA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407822877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OSAMA ELSHAZLY M.D.

Provider Business Mailing Address
First Line	:	2316 W 23RD ST
Second Line	:	STE A
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-2373
Country	:	US
Telephone Number	:	850-785-0085
Fax Number	:	850-785-0558

Provider Business Practice Location Address
First Line	:	2202 STATE AVE
Second Line	:	SUITE 102
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-7601
Country	:	US
Telephone Number	:	850-785-0085
Fax Number	:	850-785-0558

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	05/03/2019

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Directions to “ DR. OSAMA ELSHAZLY M.D.” Practice Location

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