Healthcare Provider Details

I. General information

NPI: 1831393875
Provider Name (Legal Business Name): RACHID C BAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 USF MAGNOLIA DR FOB3
TAMPA FL
33612-9416
US

IV. Provider business mailing address

12902 USF MAGNOLIA DR FOB3
TAMPA FL
33612-9416
US

V. Phone/Fax

Practice location:
  • Phone: 813-745-4623
  • Fax:
Mailing address:
  • Phone: 813-745-4623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35085773
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME101500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: