MEDICARE: DR. AHMED AL-HAZZOURI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RX0202X	Medical Oncology Physician	ME106390	FL
2	207RH0000X	Hematology (Internal Medicine) Physician	ME106390	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841482270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AHMED AL-HAZZOURI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 102222
Second Line	:	ATTENTION: CREDENTIAL DEPARTMENT
City	:	ATLANTA
State	:	GA
Zip	:	30368-2222
Country	:	US
Telephone Number	:	239-274-8200
Fax Number	:	239-278-3350

Provider Business Practice Location Address
First Line	:	1340 N HANCOCK RD
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-5952
Country	:	US
Telephone Number	:	352-394-1150
Fax Number	:	352-394-1560

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	02/09/2026

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