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12111 Panama City Beach Pkwy Panama City Beach FL 32407-2609 | |
| (850) 588-1066 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 12111 Panama City Beach Pkwy, Panama City Beach, Florida |
| Authorized Official Name and Position | Evan Ellenberg (PRESIDENT) |
| Authorized Official Contact | 8505881066 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
12111 Panama City Beach Pkwy Panama City Beach FL 32407-2609 Ph: () - | 12111 Panama City Beach Pkwy Panama City Beach FL 32407-2609 Ph: (850) 588-1066 |
| NPI Number | 1407406820 |
|---|---|
| Provider Enumeration Date | 09/17/2019 |
| Last Update Date | 11/21/2024 |
| Medicare PECOS PAC ID | 8921432683 |
|---|---|
| Medicare Enrollment ID | O20200106001113 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407406820 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Richard H Maughon |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1063559433 PECOS PAC ID: 0143377366 Enrollment ID: I20200925002013 |
| Provider Name | Tiffany Arnold Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073382313 PECOS PAC ID: 6204373046 Enrollment ID: I20240730001070 |
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