Healthcare Provider Details

I. General information

NPI: 1134250384
Provider Name (Legal Business Name): TAMPA BAY HAND CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13905 BRUCE B DOWNS BLVD SUITE B
TAMPA FL
33613-3998
US

IV. Provider business mailing address

13905 BRUCE B DOWNS BLVD SUITE B
TAMPA FL
33613-3998
US

V. Phone/Fax

Practice location:
  • Phone: 813-978-9494
  • Fax: 813-979-4817
Mailing address:
  • Phone: 813-978-9494
  • Fax: 813-979-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KHADER MUQTADIR
Title or Position: PRESIDENT / OWNER
Credential: M.D.
Phone: 813-978-9494