Provider Demographics
NPI:1215168521
Name:ATWAY, BAHA ALDEAN (DPM)
Entity type:Individual
Prefix:DR
First Name:BAHA
Middle Name:ALDEAN
Last Name:ATWAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:DEAN
Other - Middle Name:B
Other - Last Name:ATWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:505 EICHENFELD DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5985
Mailing Address - Country:US
Mailing Address - Phone:813-685-6922
Mailing Address - Fax:813-685-8308
Practice Address - Street 1:505 EICHENFELD DR
Practice Address - Street 2:SUITE 108
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5985
Practice Address - Country:US
Practice Address - Phone:813-685-6922
Practice Address - Fax:813-685-8308
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301016213E00000X
FL3377213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist