Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME59452 | FL |
N | 2080P0207X | Pediatric Hematology-Oncologist | ME 59452 | FL |
NPI | 1003897620 |
---|---|
Provider Name | Dr. Mohammed Yahia Abdul-Rahim |
First Address | Panama City, FL 32405-4628 |
Second Address | Panama City, FL 32405-4628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 02/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
052434400 | (05) | FL |
E74625 | (02) | FL |