Provider Demographics
NPI:1730570300
Name:ABDUL-RAHIM, MOHAMMED
Entity type:Organization
Organization Name:ABDUL-RAHIM, MOHAMMED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDUL-RAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-747-8787
Mailing Address - Street 1:340 W 23RD ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-7600
Mailing Address - Country:US
Mailing Address - Phone:850-747-8787
Mailing Address - Fax:
Practice Address - Street 1:340 W 23RD ST
Practice Address - Street 2:SUITE K
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7600
Practice Address - Country:US
Practice Address - Phone:850-747-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL78574208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7907172OtherAETNA
FL256892600Medicaid
FL47026OtherBLUE CROSS BLUE SHIELD
FL1975621OtherCIGNA
FL7907172OtherAETNA