Provider Demographics
NPI:1063602258
Name:MUSTAFA A HAMMAD MD PA
Entity type:Organization
Organization Name:MUSTAFA A HAMMAD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-215-7093
Mailing Address - Street 1:1931 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4704
Mailing Address - Country:US
Mailing Address - Phone:850-215-7093
Mailing Address - Fax:850-215-7096
Practice Address - Street 1:1931 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4704
Practice Address - Country:US
Practice Address - Phone:850-215-7093
Practice Address - Fax:850-215-7096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273535100Medicaid
FL6713950001Medicare NSC
FLI44374Medicare UPIN
FL273535100Medicaid