Healthcare Provider Details

I. General information

NPI: 1417374372
Provider Name (Legal Business Name): WALID TALAT AZIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WALID TALAT ABDALAZIZ

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19046 BRUCE B DOWNS BLVD # 1439
TAMPA FL
33647-2434
US

IV. Provider business mailing address

19046 BRUCE B DOWNS BLVD # 1439
TAMPA FL
33647-2434
US

V. Phone/Fax

Practice location:
  • Phone: 727-238-5911
  • Fax:
Mailing address:
  • Phone: 727-238-5911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number100661
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberME136103
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: