Provider Demographics
NPI:1801275276
Name:SHAABAN, MUHAMMAD TARIK (MD)
Entity type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:TARIK
Last Name:SHAABAN
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 1:2306 N HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-5280
Mailing Address - Country:US
Mailing Address - Phone:850-250-0021
Mailing Address - Fax:850-250-0022
Practice Address - Street 1:2306 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4404
Practice Address - Country:US
Practice Address - Phone:850-250-0021
Practice Address - Fax:850-250-0022
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME136611207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program