Provider Demographics
NPI:1609968429
Name:AYMAN T ABOULELA MD PA
Entity Type:Organization
Organization Name:AYMAN T ABOULELA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:ABOULELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-785-0085
Mailing Address - Street 1:PO BOX 15834
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32406
Mailing Address - Country:US
Mailing Address - Phone:850-785-0085
Mailing Address - Fax:850-785-0558
Practice Address - Street 1:2202 STATE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4539
Practice Address - Country:US
Practice Address - Phone:850-785-0085
Practice Address - Fax:850-785-0558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90177207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty