Provider Demographics
NPI:1861606394
Name:EBEID, HASAN
Entity type:Individual
Prefix:
First Name:HASAN
Middle Name:
Last Name:EBEID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 STATE AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-7601
Mailing Address - Country:US
Mailing Address - Phone:850-785-0321
Mailing Address - Fax:850-784-9955
Practice Address - Street 1:2202 STATE AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7601
Practice Address - Country:US
Practice Address - Phone:850-785-0321
Practice Address - Fax:850-784-9955
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111582208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004331700Medicaid