Provider Demographics
NPI:1629213053
Name:A O RIFAI MD LLC
Entity Type:Organization
Organization Name:A O RIFAI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:OUSSAMA
Authorized Official - Last Name:RIFAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-215-5911
Mailing Address - Street 1:PO BOX 1750
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-5950
Mailing Address - Country:US
Mailing Address - Phone:850-215-5911
Mailing Address - Fax:850-914-3004
Practice Address - Street 1:2507 HARRISON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4424
Practice Address - Country:US
Practice Address - Phone:850-215-5911
Practice Address - Fax:850-914-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78033207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty