Provider Demographics
NPI:1811158082
Name:BOKHARI, HASSAN AYAZ (MD)
Entity type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:AYAZ
Last Name:BOKHARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-6383
Mailing Address - Country:US
Mailing Address - Phone:727-238-3241
Mailing Address - Fax:
Practice Address - Street 1:716 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-6383
Practice Address - Country:US
Practice Address - Phone:727-238-3241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1180202084P0800X
GA828412084P0800X
LA3206372084P0800X
MDD00721792084P0804X
CAC1686592084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015036600Medicaid
MD067035900Medicaid