Healthcare Provider Details

I. General information

NPI: 1962701193
Provider Name (Legal Business Name): HUGH H WINDOM MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3570 S TUTTLE AVE
SARASOTA FL
34239-6405
US

IV. Provider business mailing address

3570 S TUTTLE AVE
SARASOTA FL
34239-6405
US

V. Phone/Fax

Practice location:
  • Phone: 941-927-4888
  • Fax: 941-927-5808
Mailing address:
  • Phone: 941-927-4888
  • Fax: 941-927-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME62095
License Number StateFL

VIII. Authorized Official

Name: DR. HUGH H WINDOM
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 941-927-4888