Provider Demographics
NPI:1013402783
Name:THYROID DIABETES ENDOCRINOLOGY AND WELLNESS INC
Entity Type:Organization
Organization Name:THYROID DIABETES ENDOCRINOLOGY AND WELLNESS INC
Other - Org Name:TDEWELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMADAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-862-2070
Mailing Address - Street 1:8075 GATE PKWY W STE 306
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3685
Mailing Address - Country:US
Mailing Address - Phone:904-862-2070
Mailing Address - Fax:904-508-0228
Practice Address - Street 1:8075 GATE PKWY W STE 306
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-3685
Practice Address - Country:US
Practice Address - Phone:904-862-2070
Practice Address - Fax:904-508-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty