Provider Demographics
NPI:1609802073
Name:EL BATAINEH, REZEQ F (MD)
Entity Type:Individual
Prefix:DR
First Name:REZEQ
Middle Name:F
Last Name:EL BATAINEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 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:850-785-6272
Mailing Address - Fax:850-785-8686
Practice Address - Street 1:2575 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:850-785-6272
Practice Address - Fax:850-785-8686
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2015-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0070013207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593373618OtherTAX IDENTIFICATION
FL28519OtherBCBS OF FL
FL379350800Medicaid
FL593373618OtherTAX IDENTIFICATION
FL28519OtherBCBS OF FL
FL593373618OtherTAX IDENTIFICATION