MEDICARE: MEDICAL CLINIC PCB

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	ME94438	FL

General Provider Information

NPI Number	:	1700180130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CLINIC PCB

Provider Business Mailing Address
First Line	:	8317 FRONT BEACH RD STE 37B
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-4896
Country	:	US
Telephone Number	:	850-249-1002
Fax Number	:	850-769-2366

Provider Business Practice Location Address
First Line	:	8317 FRONT BEACH RD STE 37B
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-4896
Country	:	US
Telephone Number	:	850-249-1002
Fax Number	:	850-769-2366

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. ROBERT B SPERRAZZA
Credential	:	M.D.
Telephone Number	:	850-249-1002

Provider Enumeration Date	:	12/28/2010
Last Update Date	:	12/28/2010

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