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General NPI Number Information
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NPI Number | 1861870636
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Entity Type | Individual
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Provider Name | GREGORY AZZAM MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 05/13/2015
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 1611 NW 12TH AVE
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City | MIAMI
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State | FL
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Zip | 33136-1005
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Country | US
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Telephone | 305-243-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 1475 NW 12TH AVE 1500
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City | MIAMI
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State | FL
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Zip | 33136-1002
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Country | US
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Telephone | 305-243-4200
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | ME145753
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License Number State | FL
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