Provider Demographics
NPI:1912967142
Name:HAMMAD, MUSTAFA A (MD,)
Entity Type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:A
Last Name:HAMMAD
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 1:1931 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-5314
Mailing Address - Country:US
Mailing Address - Phone:850-215-7093
Mailing Address - Fax:850-215-7096
Practice Address - Street 1:1931 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5314
Practice Address - Country:US
Practice Address - Phone:850-215-7093
Practice Address - Fax:850-215-7096
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93997204D00000X, 2084N0400X, 208VP0014X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29436OtherBCBS OF FLORIDA
FLP00686249OtherRAILROAD MEDICARE PALMETTO GBA
FL273535100Medicaid
FL273534200Medicaid
FLP00686249OtherRAILROAD MEDICARE PALMETTO GBA
FLI44374Medicare UPIN
FL29436OtherBCBS OF FLORIDA
29436YMedicare PIN