Provider Demographics
NPI:1134569049
Name:RAINBOW PEDIATRICS PC LLC
Entity type:Organization
Organization Name:RAINBOW PEDIATRICS PC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:REZK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-356-6245
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-0578
Mailing Address - Country:US
Mailing Address - Phone:850-767-4777
Mailing Address - Fax:850-763-4988
Practice Address - Street 1:200 FOREST PARK CIR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4915
Practice Address - Country:US
Practice Address - Phone:850-257-5524
Practice Address - Fax:850-257-5638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1055202080A0000X, 2080N0001X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008959200Medicaid