Provider Demographics
NPI:1730275215
Name:ABDUL RAHIM, MOHAMMED (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:ABDUL RAHIM
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 1:340 WEST 23RD ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405
Mailing Address - Country:US
Mailing Address - Phone:850-747-8787
Mailing Address - Fax:850-747-8624
Practice Address - Street 1:340 WEST 23RD ST
Practice Address - Street 2:SUITE K
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:850-747-8787
Practice Address - Fax:850-747-8624
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL78574208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1975621OtherCIGNA
7907172OtherAETNA
47026OtherBLUE CROSS/BLUE SHIELD
FL256892600Medicaid