Provider Demographics
NPI:1831262229
Name:GULF COAST MEDICAL AND GERIATRIC CLINIC INC
Entity type:Organization
Organization Name:GULF COAST MEDICAL AND GERIATRIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LIAQAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-522-0182
Mailing Address - Street 1:PO BOX 1317
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-6117
Mailing Address - Country:US
Mailing Address - Phone:850-522-0182
Mailing Address - Fax:850-522-0184
Practice Address - Street 1:237 E BALDWIN RD STE 102
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4463
Practice Address - Country:US
Practice Address - Phone:850-522-0182
Practice Address - Fax:850-522-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83788207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty