Provider Demographics
NPI:1750480695
Name:FOREST PARK MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:FOREST PARK MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSH
Authorized Official - Middle Name:E
Authorized Official - Last Name:AKIN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:850-785-6141
Mailing Address - Street 1:304 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4506
Mailing Address - Country:US
Mailing Address - Phone:850-785-6141
Mailing Address - Fax:850-763-0404
Practice Address - Street 1:304 W 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4506
Practice Address - Country:US
Practice Address - Phone:850-785-6141
Practice Address - Fax:850-763-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCK7893OtherRAILROAD MEDICARE
FLK3621Medicare ID - Type UnspecifiedPROVIDER NUMBER