Healthcare Provider Details

I. General information

NPI: 1669637591
Provider Name (Legal Business Name): HAYDER H. AL-AZZAWI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HAYDER HAITHAM AL-AZZAWI M.D.

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N FLAGLER DR STE 4900
WEST PALM BEACH FL
33401-3404
US

IV. Provider business mailing address

PO BOX 20800
BELFAST ME
04915-4105
US

V. Phone/Fax

Practice location:
  • Phone: 561-835-3396
  • Fax: 561-835-3397
Mailing address:
  • Phone: 888-402-7256
  • Fax: 888-902-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME112271
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME112271
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: