Provider Demographics
NPI:1841482270
Name:AL-HAZZOURI, AHMED (MD)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:AL-HAZZOURI
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:PO BOX 102222
Mailing Address - Street 2:ATTENTION: CREDENTIAL DEPARTMENT
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:1920 DON WICKHAM DR STE 100
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1977
Practice Address - Country:US
Practice Address - Phone:352-394-1150
Practice Address - Fax:352-394-1560
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106390207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002509600Medicaid
FLDQ520XMedicare PIN
FLDQ520WMedicare PIN