Provider Demographics
NPI:1164508354
Name:HOSSAIN, TAWHID SIMON (MD)
Entity Type:Individual
Prefix:
First Name:TAWHID
Middle Name:SIMON
Last Name:HOSSAIN
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 1:301 HEALTH PARK BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:904-823-3394
Mailing Address - Fax:904-823-8557
Practice Address - Street 1:301 HEALTH PARK BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-823-3394
Practice Address - Fax:904-823-8557
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070047207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4293890001Medicare NSC
G58880Medicare UPIN
FL45090AMedicare ID - Type Unspecified