Provider Demographics
NPI:1932728995
Name:ALL AGES PEDIATRICS PA
Entity type:Organization
Organization Name:ALL AGES PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-FARAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-496-8095
Mailing Address - Street 1:2717 TALON CT
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-6672
Mailing Address - Country:US
Mailing Address - Phone:407-496-8095
Mailing Address - Fax:850-547-8090
Practice Address - Street 1:2910 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-4268
Practice Address - Country:US
Practice Address - Phone:850-547-8158
Practice Address - Fax:850-547-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty