Provider Demographics
NPI:1528629144
Name:DREAM MEDICAL LLC
Entity type:Organization
Organization Name:DREAM MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHORES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-763-8000
Mailing Address - Street 1:2103 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4511
Mailing Address - Country:US
Mailing Address - Phone:850-763-8000
Mailing Address - Fax:850-785-1122
Practice Address - Street 1:3009 4TH ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2122
Practice Address - Country:US
Practice Address - Phone:850-763-8000
Practice Address - Fax:850-785-1122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DREAM MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty