Provider Demographics
NPI:1801804117
Name:MANZOOR, AMIR (MD)
Entity type:Individual
Prefix:DR
First Name:AMIR
Middle Name:
Last Name:MANZOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 15878
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32406-5878
Mailing Address - Country:US
Mailing Address - Phone:850-770-4051
Mailing Address - Fax:850-770-4051
Practice Address - Street 1:237 E BALDWIN ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:850-770-4051
Practice Address - Fax:850-770-4059
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72435207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255936600Medicaid
FL255936600Medicaid
FL46288ZMedicare PIN