Provider Demographics
NPI:1760554844
Name:MEDICAL ASSOCIATES OF TAMARAC PA
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF TAMARAC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVEROLD
Authorized Official - Middle Name:ESMILE
Authorized Official - Last Name:HAFFIZULLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-726-0099
Mailing Address - Street 1:7875 W COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33351-4353
Mailing Address - Country:US
Mailing Address - Phone:954-726-0099
Mailing Address - Fax:954-726-0047
Practice Address - Street 1:7875 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33351-4353
Practice Address - Country:US
Practice Address - Phone:954-726-0099
Practice Address - Fax:954-726-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97618Medicare PIN