Healthcare Provider Details

I. General information

NPI: 1336190974
Provider Name (Legal Business Name): FOUAD MAURICE HAJJAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE SUITE 589
ORLANDO FL
32804-4603
US

IV. Provider business mailing address

2501 N ORANGE AVE SUITE 589
ORLANDO FL
32804-4603
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2080
  • Fax: 407-303-2085
Mailing address:
  • Phone: 407-303-2080
  • Fax: 407-303-2085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberME66648
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: