Healthcare Provider Details

I. General information

NPI: 1598493074
Provider Name (Legal Business Name): DR. RAMEZ AZZAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER ROAD
GAINESVILLE FL
32610
US

IV. Provider business mailing address

PO BOX 100289
GAINESVILLE FL
32610-0133
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-9804
  • Fax:
Mailing address:
  • Phone: 352-273-9804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberRTL22-0451
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME170130
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: