Healthcare Provider Details

I. General information

NPI: 1841301116
Provider Name (Legal Business Name): FAUZIA F. QUDDUS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15465 OAK LN SUITE 100-F
GULFPORT MS
39503-2663
US

IV. Provider business mailing address

15465 OAK LN SUITE 100-F
GULFPORT MS
39503-2663
US

V. Phone/Fax

Practice location:
  • Phone: 228-832-0414
  • Fax: 228-832-8227
Mailing address:
  • Phone: 228-832-0414
  • Fax: 228-832-8227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14692
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: