MEDICARE: FOREST PARK MEDICAL ASSOCIATES

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CK7893	OTHER	FL	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1750480695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREST PARK MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	304 W 23RD ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4506
Country	:	US
Telephone Number	:	850-785-6141
Fax Number	:	850-763-0404

Provider Business Practice Location Address
First Line	:	304 W 23RD ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4506
Country	:	US
Telephone Number	:	850-785-6141
Fax Number	:	850-763-0404

Authorized Official
Title or Position	:	PHYSICIAN/PRESIDENT
Name	:	DR. RUSH E AKIN SR.
Credential	:	M.D.
Telephone Number	:	850-785-6141

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	10/25/2007

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Directions to “FOREST PARK MEDICAL ASSOCIATES ” Practice Location

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