Healthcare Provider Details

I. General information

NPI: 1407848195
Provider Name (Legal Business Name): MATTHEW KOBINA HASFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 HOLLYWOOD BLVD STE 3A
HOLLYWOOD FL
33021-6736
US

IV. Provider business mailing address

3939 HOLLYWOOD BLVD STE 3A
HOLLYWOOD FL
33021-6736
US

V. Phone/Fax

Practice location:
  • Phone: 305-836-1090
  • Fax: 305-836-1199
Mailing address:
  • Phone: 305-836-1090
  • Fax: 305-836-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301513068
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number84819
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME101466
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: