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General NPI Number Information
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NPI Number | 1417918988
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Entity Type | Individual
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Provider Name | AZZAM MUFTAH M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 15205 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-6072
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Country | US
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Telephone | 352-597-7744
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Fax | 352-597-7797
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Provider Business Mailing Address
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Address Line | 5400 PINEHURST DR
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City | SPRING HILL
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State | FL
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Zip | 34606-3833
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Country | US
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Telephone | 352-277-5305
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Fax | 352-616-0926
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME68485
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License Number State | FL
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