Provider Demographics
NPI:1548392475
Name:TAMIM, PATRICK MARWAN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:MARWAN
Last Name:TAMIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E 23RD ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-7612
Mailing Address - Country:US
Mailing Address - Phone:850-215-9654
Mailing Address - Fax:850-215-6934
Practice Address - Street 1:221 E 23RD ST
Practice Address - Street 2:SUITE E
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7612
Practice Address - Country:US
Practice Address - Phone:850-215-9654
Practice Address - Fax:850-215-6934
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME980032086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93784OtherBCBS
FL93784OtherBCBS