Provider Demographics
NPI:1508021684
Name:MARIUSZ J KLIN M D P A
Entity Type:Organization
Organization Name:MARIUSZ J KLIN M D P A
Other - Org Name:EMERALD COAST GASTROENTEROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-215-7071
Mailing Address - Street 1:2202 STATE AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-7601
Mailing Address - Country:US
Mailing Address - Phone:850-215-7071
Mailing Address - Fax:850-215-7073
Practice Address - Street 1:2202 STATE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7601
Practice Address - Country:US
Practice Address - Phone:850-215-7071
Practice Address - Fax:850-215-7073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85851207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty