Provider Demographics
NPI:1245208735
Name:PANAMA CITY INFECTIOUS DISEASE ASSOCIATES PA
Entity Type:Organization
Organization Name:PANAMA CITY INFECTIOUS DISEASE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:BONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-763-8596
Mailing Address - Street 1:2579 HUNTCLIFF LN
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4902
Mailing Address - Country:US
Mailing Address - Phone:850-763-8596
Mailing Address - Fax:850-784-6774
Practice Address - Street 1:2579 HUNTCLIFF LN
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4902
Practice Address - Country:US
Practice Address - Phone:850-763-8596
Practice Address - Fax:850-784-6774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94925OtherBCBS OF FLORIDA
FL264643900Medicaid
FL264643900Medicaid