Provider Demographics
NPI:1962701193
Name:HUGH H WINDOM MD PA
Entity type:Organization
Organization Name:HUGH H WINDOM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:H
Authorized Official - Last Name:WINDOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-927-4888
Mailing Address - Street 1:3570 S TUTTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6405
Mailing Address - Country:US
Mailing Address - Phone:941-927-4888
Mailing Address - Fax:941-927-5808
Practice Address - Street 1:3570 S TUTTLE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6405
Practice Address - Country:US
Practice Address - Phone:941-927-4888
Practice Address - Fax:941-927-5808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-28
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62095207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370374600Medicaid
FL370374600Medicaid