Provider Demographics
NPI:1841305398
Name:BAYSIDE SURGICAL ASSOCIATES
Entity type:Organization
Organization Name:BAYSIDE SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHIREEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-276-1328
Mailing Address - Street 1:2933 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4411
Mailing Address - Country:US
Mailing Address - Phone:850-913-6958
Mailing Address - Fax:850-913-6959
Practice Address - Street 1:2933 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4411
Practice Address - Country:US
Practice Address - Phone:850-913-6958
Practice Address - Fax:850-913-6959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty