Healthcare Provider Details

I. General information

NPI: 1760488506
Provider Name (Legal Business Name): MOHAMED AZZOUZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 TOLL GATE RD STE 201
WARWICK RI
02886-4466
US

IV. Provider business mailing address

215 TOLL GATE RD SUITE 201
WARWICK RI
02886-4458
US

V. Phone/Fax

Practice location:
  • Phone: 401-681-4930
  • Fax: 401-681-4932
Mailing address:
  • Phone: 401-681-4930
  • Fax: 401-681-4932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD10233
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: