1801989017 NPI number — DR. MUTAZ B HABAL M.D.

Table of content: DR. MUTAZ B HABAL M.D. (NPI 1801989017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801989017 NPI number — DR. MUTAZ B HABAL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HABAL
Provider First Name:
MUTAZ
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801989017
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 W DR MARTIN LUTHER KING JR BLVD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33603-3600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-238-0409
Provider Business Mailing Address Fax Number:
813-238-1119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 W DR MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33603-3600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-238-0409
Provider Business Practice Location Address Fax Number:
813-238-1119
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  ME21292 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2082S0099X , with the licence number: ME21292 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: ME21292 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 202540 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 592023224 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 68008 . This is a "BLUE CROSS & BLUE SIHELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 01047 . This is a "STAYWELL-WELLCARE-HEALTHEASE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1247218 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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