Healthcare Provider Details

I. General information

NPI: 1124255005
Provider Name (Legal Business Name): TAGHRID A ALTOOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 N. MCMULLEN BOOTH ROAD
CLEARWATER FL
33761-2008
US

IV. Provider business mailing address

3155 N. MCMULLEN BOOTH ROAD
CLEARWATER FL
33761-2008
US

V. Phone/Fax

Practice location:
  • Phone: 727-669-9018
  • Fax: 727-797-6047
Mailing address:
  • Phone: 727-669-9018
  • Fax: 727-797-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL3356
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME119912
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: