Provider Demographics
NPI:1235150863
Name:PANAMA CITY PEDIATRICS PA
Entity Type:Organization
Organization Name:PANAMA CITY PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EEHAB
Authorized Official - Middle Name:A
Authorized Official - Last Name:KENAWY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-747-3661
Mailing Address - Street 1:PO BOX 15697
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32406-5697
Mailing Address - Country:US
Mailing Address - Phone:850-747-3048
Mailing Address - Fax:850-747-0194
Practice Address - Street 1:1937 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4543
Practice Address - Country:US
Practice Address - Phone:850-747-3048
Practice Address - Fax:850-747-0194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91470208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94947OtherBCBS FLORIDA