Healthcare Provider Details

I. General information

NPI: 1013902204
Provider Name (Legal Business Name): HUGH H WINDOM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2005
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 Code207KA0200X
TaxonomyAllergy Physician
License NumberME0062095
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: