Provider Demographics
NPI:1972791002
Name:ELZAWAHRY, HODA K (MD)
Entity Type:Individual
Prefix:
First Name:HODA
Middle Name:K
Last Name:ELZAWAHRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 STATE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4582
Mailing Address - Country:US
Mailing Address - Phone:850-785-0029
Mailing Address - Fax:
Practice Address - Street 1:2202 STATE AVE STE 201
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4582
Practice Address - Country:US
Practice Address - Phone:850-785-0029
Practice Address - Fax:850-785-7600
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43015028862084N0400X
WI676512084N0400X
CAC-1528752084N0400X
KS04401912084N0400X
KY516682084N0400X
MEMD250412084N0400X
FLME105738207R00000X, 2084N0400X
NJ25MA100080002084N0400X
IL036.1419272084N0400X
NC2021-013412084N0400X
AZ641082084N0400X
CT672122084N0400X
GA897682084N0400X
IN01078173A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002113600Medicaid
CX787ZMedicare PIN