Provider Demographics
NPI:1306202197
Name:BRIGHT PEDIATRICS
Entity Type:Organization
Organization Name:BRIGHT PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SAMEH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELAMIR
Authorized Official - Suffix:X
Authorized Official - Credentials:MD
Authorized Official - Phone:850-257-5147
Mailing Address - Street 1:340 W 23RD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-7600
Mailing Address - Country:US
Mailing Address - Phone:850-257-5147
Mailing Address - Fax:850-257-5886
Practice Address - Street 1:3520 E 15TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-5831
Practice Address - Country:US
Practice Address - Phone:850-763-4104
Practice Address - Fax:850-763-6689
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIGHT PEDIATRICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111081261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004305100Medicaid