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General NPI Number Information
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NPI Number | 1851551162
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Entity Type | Individual
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Provider Name | ESSAM KAZMOUZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 03/13/2023
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Provider Practice Location Address
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Address Line | 11187 SAND PINE CT
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City | FORT MYERS
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State | FL
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Zip | 33913-8813
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Country | US
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Telephone | 239-233-5029
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 LEE BLVD
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City | LEHIGH ACRES
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State | FL
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Zip | 33936-4835
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Country | US
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Telephone | 813-562-9744
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Fax |
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 37970
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | ME100969
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License Number State | FL
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