Individual
DR. MUTAZ A TABBAA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2559 HUNTCLIFF LN, PANAMA CITY, FL 32405-4902
(850) 763-0333
(850) 763-1477
Mailing address
2559 HUNTCLIFF LN, PANAMA CITY, FL 32405-4902
(850) 763-0333
(850) 763-1477
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME48669
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01496
BCBS PROVIDER NUMBER
FL
05
—
044278000
—
FL
01
—
130018687
RAILROAD MEDICARE NUMBER
FL
01
—
D50170
UPIN
FL
Enumeration date
08/07/2007
Last updated
08/07/2007
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