Provider Demographics
NPI:1720117690
Name:POONAI, PARMANAND VIJAY (MD)
Entity Type:Individual
Prefix:DR
First Name:PARMANAND
Middle Name:VIJAY
Last Name:POONAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SUNSET CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-2115
Mailing Address - Country:US
Mailing Address - Phone:850-229-8348
Mailing Address - Fax:850-229-8630
Practice Address - Street 1:103 SUNSET CIR
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-2115
Practice Address - Country:US
Practice Address - Phone:850-229-8348
Practice Address - Fax:850-229-8630
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27071207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23016Medicare ID - Type UnspecifiedGENERAL SURGERY