Provider Demographics
NPI:1194846352
Name:HAQ MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:HAQ MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IFTIKHAR
Authorized Official - Middle Name:FAZAL
Authorized Official - Last Name:HAQ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:386-325-4999
Mailing Address - Street 1:800 ZEAGLER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3883
Mailing Address - Country:US
Mailing Address - Phone:386-325-4999
Mailing Address - Fax:386-325-4777
Practice Address - Street 1:800 ZEAGLER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3883
Practice Address - Country:US
Practice Address - Phone:386-325-4999
Practice Address - Fax:386-325-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 6099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371351200Medicaid
FLF61434Medicare UPIN
FLK8476 80804ZMedicare ID - Type Unspecified