Provider Demographics
NPI:1124134093
Name:ROHAN, KEVIN EDWARD (PA-C)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:EDWARD
Last Name:ROHAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HARVARD CIR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3554
Mailing Address - Country:US
Mailing Address - Phone:850-890-2412
Mailing Address - Fax:850-872-9059
Practice Address - Street 1:408 W 19TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4602
Practice Address - Country:US
Practice Address - Phone:850-769-5400
Practice Address - Fax:850-872-9059
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103876363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAB725ZOtherMEDICARE PROVIDER #