Provider Demographics
NPI:1104092691
Name:GENERAL SURGERY OF PANAMA CITY INC
Entity type:Organization
Organization Name:GENERAL SURGERY OF PANAMA CITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HATEM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-215-7162
Mailing Address - Street 1:PO BOX 1759
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77251-1759
Mailing Address - Country:US
Mailing Address - Phone:850-215-7162
Mailing Address - Fax:850-215-7156
Practice Address - Street 1:2633 HWY 77 UNIT B
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4406
Practice Address - Country:US
Practice Address - Phone:850-215-7162
Practice Address - Fax:850-215-7156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95473208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty