MEDICARE: BRAIN AND SPINE LLC

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	174400000X	Specialist
2	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1942317896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAIN AND SPINE LLC

Provider Business Mailing Address
First Line	:	2202 STATE AVE STE 201
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4582
Country	:	US
Telephone Number	:	850-785-0029
Fax Number	:	850-785-7600

Provider Business Practice Location Address
First Line	:	2202 STATE AVE STE 201
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4582
Country	:	US
Telephone Number	:	850-785-0029
Fax Number	:	850-785-7600

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	KYLIE M MARLETTE
Credential	:
Telephone Number	:	850-215-1593

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	05/01/2023

Similar Medicare Providers

1619964046 — DR. RAMADA SHERICE SMITH M.D.
Practice Location Address:

2202 STATE AVE STE 207
PANAMA CITY, FL
32405-4582

Practice Phone: 850-874-1856
Practice Fax: 850-784-1975

1730167057 — DR. GRANT ADAM KIDD D.O.
Practice Location Address:

2202 STATE AVE STE 201
PANAMA CITY, FL
32405-4582

Practice Phone: 850-785-0029
Practice Fax: 850-785-7600

1780644997 — MRS. KARIN STRINGER MADDOX M.D.
Practice Location Address:

2202 STATE AVE STE 201
PANAMA CITY, FL
32405-4582

Practice Phone: 850-785-0029
Practice Fax: 850-785-6388

1659331767 — KAMEL ELZAWAHRY MD
Practice Location Address:

2202 STATE AVE STE 201
PANAMA CITY, FL
32405-4582

Practice Phone: 850-785-0029
Practice Fax: 850-785-7600

1780632380 — RAHMAN SHAH MD
Practice Location Address:

2202 STATE AVE STE 207
PANAMA CITY, FL
32405-4582

Practice Phone: 850-872-3939
Practice Fax: 850-872-3938

1649296088 — GULF COAST MULTISPECIALITY SERVICES, LLC
Practice Location Address:

2202 STATE AVE , SUITE 207
PANAMA CITY, FL
32405-4582

Practice Phone: 850-784-1856
Practice Fax: 850-784-1975

Directions to “BRAIN AND SPINE LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.