Provider Demographics
NPI:1780733568
Name:BEKELE, GENENE M (MD)
Entity type:Individual
Prefix:DR
First Name:GENENE
Middle Name:M
Last Name:BEKELE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:633 E BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4207
Mailing Address - Country:US
Mailing Address - Phone:480-922-3009
Mailing Address - Fax:480-922-3103
Practice Address - Street 1:633 E BALDWIN RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4207
Practice Address - Country:US
Practice Address - Phone:480-922-3009
Practice Address - Fax:480-922-3103
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME155222207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ405739Medicaid
AZ405739Medicaid
AZG65816Medicare UPIN