Healthcare Provider Details

I. General information

NPI: 1235306820
Provider Name (Legal Business Name): T S HOSSAIN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HEALTH PARK BLVD SUITE #215
ST AUGUSTINE FL
32086
US

IV. Provider business mailing address

301 HEALTH PARK BLVD SUITE #215
ST AUGUSTINE FL
32086
US

V. Phone/Fax

Practice location:
  • Phone: 904-823-3394
  • Fax: 904-823-8557
Mailing address:
  • Phone: 904-823-3394
  • Fax: 904-823-8557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAWHID SIMON HOSSAIN
Title or Position: PRESIDENT
Credential: MD
Phone: 904-823-3394