Healthcare Provider Details

I. General information

NPI: 1538335468
Provider Name (Legal Business Name): MUWAFAQ MUHAMMED ALHOMSI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

14619 DAYBREAK DR
LUTZ FL
33559-3237
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0077
  • Fax:
Mailing address:
  • Phone: 813-486-8553
  • Fax: 813-910-4246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number12176
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: