Provider Demographics
NPI:1083905640
Name:ABUGRARA, HAZEM LOUAE (MD)
Entity Type:Individual
Prefix:DR
First Name:HAZEM
Middle Name:LOUAE
Last Name:ABUGRARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HAZEM
Other - Middle Name:L
Other - Last Name:ABUGRARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3001 W DR MLK BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6307
Mailing Address - Country:US
Mailing Address - Phone:813-870-4933
Mailing Address - Fax:813-870-4887
Practice Address - Street 1:3001 W DR MARTIN LUTHER KING JR BLVD FL 3
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6307
Practice Address - Country:US
Practice Address - Phone:813-870-4933
Practice Address - Fax:813-870-4887
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121863207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018145200Medicaid