Basic Information
| Provider Information | |||||||||
| NPI: | 1114149481 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | M. NAZIR HAMOUI MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12900 CORTEZ BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525961101 | ||||||||
| FaxNumber: | 3525967869 | ||||||||
| Practice Location | |||||||||
| Address1: | 12900 CORTEZ BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525961101 | ||||||||
| FaxNumber: | 3525967869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 01/25/2012 | ||||||||
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| AuthorizedOfficialLastName: | HAMOUI | ||||||||
| AuthorizedOfficialFirstName: | M. | ||||||||
| AuthorizedOfficialMiddleName: | NAZIR | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3525961101 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | M. NAZIR HAMOUI MD | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | ME34613 | FL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology | 208800000X | ME0034613 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 0589700001 | 01 | FL | NSC | OTHER |