Provider Demographics
NPI:1366680357
Name:BEGUM, TOHMINA (MD)
Entity Type:Individual
Prefix:
First Name:TOHMINA
Middle Name:
Last Name:BEGUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 SW STATE ROAD 47
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-0489
Mailing Address - Country:US
Mailing Address - Phone:386-438-5255
Mailing Address - Fax:386-438-5618
Practice Address - Street 1:1283 SW STATE ROAD 47
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-0489
Practice Address - Country:US
Practice Address - Phone:386-438-5255
Practice Address - Fax:386-438-5618
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109244207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003586100Medicaid
FLFF372YMedicare PIN