MEDICARE: BRIGHT PEDIATRICS INC.

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	208000000X	Pediatrics Physician	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	:	1497022685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT PEDIATRICS INC.

Provider Business Mailing Address
First Line	:	PO. BOX 1491
Second Line	:
City	:	LYNN HAVEN
State	:	FL
Zip	:	32444-5431
Country	:	US
Telephone Number	:	850-763-4104
Fax Number	:	850-763-6689

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	:	PRESIDENT
Name	:	SAMEH MOHAMED ELAMIR
Credential	:	MD
Telephone Number	:	850-763-4104

Provider Enumeration Date	:	11/16/2011
Last Update Date	:	03/08/2012

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