Provider Demographics
NPI:1760441133
Name:TAWFIK, SAMY (MD)
Entity type:Individual
Prefix:DR
First Name:SAMY
Middle Name:
Last Name:TAWFIK
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 1:2200 W 33RD ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-1902
Mailing Address - Country:US
Mailing Address - Phone:803-361-4676
Mailing Address - Fax:
Practice Address - Street 1:140 N RICHARD JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2562
Practice Address - Country:US
Practice Address - Phone:508-636-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC225622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC225624Medicaid
SCH80366Medicare UPIN
SCH803660281Medicare ID - Type Unspecified