| Entity Name: | SAFWAN SHAMS M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 08 Nov 1982 (42 years ago) |
| Document Number: | G07579 |
| FEI/EIN Number | 592230841 |
| Address: | 61 MEMORIAL MED. PKWY., SUITE 1-800A, PALM COAST, FL, 32164 |
| Mail Address: | P.O. BOX 350657, PALM COAST, FL, 32135 |
| ZIP code: | 32164 |
| County: | Flagler |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093860199 | 2007-01-25 | 2020-08-22 | PO BOX 883, BUNNELL, FL, 321100883, US | 61 MEMORIAL MEDICAL PKWY, SUITE 1-800A, PALM COAST, FL, 321645981, US | |||||||||||||||||||||||||||
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| Phone | +1 386-586-1810 |
| Fax | 3865861811 |
Authorized person
| Name | DR. SAFWAN SHAMS |
| Role | PRESIDENT |
| Phone | 3865861810 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME036504 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| License Number | ME036504 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| SHAMS, M.D. SAFWAN | Agent | 27 FLAGLER PLACE, PALM COAST, FL, 32137 |
| Name | Role | Address |
|---|---|---|
| SHAMS,M.D. SAFWAN | President | 27 FLAGLER PLACE, PALM COAST, FL, 32137 |
| Name | Role | Address |
|---|---|---|
| SHAMS,M.D. SAFWAN | Director | 27 FLAGLER PLACE, PALM COAST, FL, 32137 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
