Provider Demographics
NPI:1124255005
Name:ALTOOS, TAGHRID A (MD)
Entity type:Individual
Prefix:MRS
First Name:TAGHRID
Middle Name:A
Last Name:ALTOOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 N. MCMULLEN BOOTH ROAD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2008
Mailing Address - Country:US
Mailing Address - Phone:727-669-9018
Mailing Address - Fax:727-797-6047
Practice Address - Street 1:3155 N. MCMULLEN BOOTH ROAD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2008
Practice Address - Country:US
Practice Address - Phone:727-669-9018
Practice Address - Fax:727-797-6047
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL3356390200000X
FLME1199122085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
HV207ZMedicare PIN