Provider Demographics
NPI:1003897620
Name:ABDUL-RAHIM, MOHAMMED YAHIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:YAHIA
Last Name:ABDUL-RAHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4628
Mailing Address - Country:US
Mailing Address - Phone:850-872-0021
Mailing Address - Fax:850-872-0553
Practice Address - Street 1:200 W 19TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4628
Practice Address - Country:US
Practice Address - Phone:850-872-0021
Practice Address - Fax:850-872-0553
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59452208000000X
FLME 594522080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052434400Medicaid
FL052434400Medicaid