Provider Demographics
NPI:1033608765
Name:CHAKRA, RAYEN-AYOUB
Entity Type:Individual
Prefix:
First Name:RAYEN-AYOUB
Middle Name:
Last Name:CHAKRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 LISENBY AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3730
Mailing Address - Country:US
Mailing Address - Phone:850-807-4420
Mailing Address - Fax:850-862-0605
Practice Address - Street 1:1710 LISENBY AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3730
Practice Address - Country:US
Practice Address - Phone:850-807-4420
Practice Address - Fax:850-862-0605
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA92836207RI0200X
390200000X
FLME162228207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program