Provider Demographics
NPI:1184838187
Name:REZK, AHMED ELSAYED (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:ELSAYED
Last Name:REZK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AHMED
Other - Middle Name:E
Other - Last Name:REZK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:200 FOREST PARK CIR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4915
Mailing Address - Country:US
Mailing Address - Phone:850-257-5524
Mailing Address - Fax:850-257-5638
Practice Address - Street 1:200 FOREST PARK CIR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4915
Practice Address - Country:US
Practice Address - Phone:850-257-5524
Practice Address - Fax:850-257-5638
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1055202080N0001X, 208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001618300Medicaid