MEDICARE: GULF COAST MEDICAL DOCTORS

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	405300000X	Prevention Professional	ME90177	FL

General Provider Information

NPI Number	:	1700312824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF COAST MEDICAL DOCTORS

Provider Business Mailing Address
First Line	:	PO BOX 15834
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32406-5834
Country	:	US
Telephone Number	:	850-769-1566
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 W 23RD ST
Second Line	:	SUITE N5
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-7610
Country	:	US
Telephone Number	:	850-769-1566
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AYMAN ABOULELA
Credential	:	MD
Telephone Number	:	850-769-1566

Provider Enumeration Date	:	05/10/2017
Last Update Date	:	05/10/2017

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