Provider Demographics
NPI:1669887139
Name:AL-FARAWI, KHALED MOHAMMED (MD)
Entity type:Individual
Prefix:
First Name:KHALED
Middle Name:MOHAMMED
Last Name:AL-FARAWI
Suffix:
Gender:
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:PO BOX 15775
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32406-5775
Mailing Address - Country:US
Mailing Address - Phone:304-521-5337
Mailing Address - Fax:850-248-2469
Practice Address - Street 1:528 W BALDWIN RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3313
Practice Address - Country:US
Practice Address - Phone:850-522-1522
Practice Address - Fax:850-522-5925
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU5058207P00000X
FLME131759208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020590600Medicaid