Provider Demographics
NPI:1669637591
Name:AL-AZZAWI, HAYDER HAITHAM (MD)
Entity Type:Individual
Prefix:
First Name:HAYDER
Middle Name:HAITHAM
Last Name:AL-AZZAWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HAYDER HAITHAM
Other - Middle Name:
Other - Last Name:AL-AZZAWI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1411 N FLAGLER DR
Mailing Address - Street 2:STE 4900
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3404
Mailing Address - Country:US
Mailing Address - Phone:561-835-3396
Mailing Address - Fax:561-835-3397
Practice Address - Street 1:1411 N FLAGLER DR
Practice Address - Street 2:STE 4900
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3404
Practice Address - Country:US
Practice Address - Phone:561-835-3396
Practice Address - Fax:561-835-3397
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11013340A390200000X
FLME112271208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208600000XAllopathic & Osteopathic PhysiciansSurgery