Provider Demographics
NPI:1114016920
Name:HAKIM, MAZEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAZEN
Middle Name:
Last Name:HAKIM
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 1859
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-1859
Mailing Address - Country:US
Mailing Address - Phone:256-543-3877
Mailing Address - Fax:256-543-1539
Practice Address - Street 1:1026 GOODYEAR AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1102
Practice Address - Country:US
Practice Address - Phone:256-543-3877
Practice Address - Fax:256-543-1539
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00017934207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE91087Medicare UPIN
AL051507690Medicare ID - Type Unspecified