Healthcare Provider Details

I. General information

NPI: 1174963326
Provider Name (Legal Business Name): HOF PULM & SLEEP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 WEBB DR STE 2
DAVENPORT FL
33837-3944
US

IV. Provider business mailing address

PO BOX 129
DAVENPORT FL
33836-0129
US

V. Phone/Fax

Practice location:
  • Phone: 863-419-7509
  • Fax: 863-419-7824
Mailing address:
  • Phone: 863-419-7509
  • Fax: 863-419-7824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME101230
License Number StateFL

VIII. Authorized Official

Name: MAHMOUD F BAKEER
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 865-274-8047