Provider Demographics
NPI:1558558171
Name:AMIR MANZOOR, MD, PA
Entity Type:Organization
Organization Name:AMIR MANZOOR, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-770-4051
Mailing Address - Street 1:PO BOX 15878
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32406-5878
Mailing Address - Country:US
Mailing Address - Phone:850-770-4051
Mailing Address - Fax:850-770-4059
Practice Address - Street 1:237 E BALDWIN RD
Practice Address - Street 2:#103
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4205
Practice Address - Country:US
Practice Address - Phone:850-770-4051
Practice Address - Fax:850-770-4059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072435174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4348Medicare PIN