Provider Demographics
NPI:1013902204
Name:WINDOM, HUGH H (MD)
Entity Type:Individual
Prefix:DR
First Name:HUGH
Middle Name:H
Last Name:WINDOM
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 1:3570 S TUTTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6405
Mailing Address - Country:US
Mailing Address - Phone:941-927-4888
Mailing Address - Fax:941-927-5808
Practice Address - Street 1:3570 S TUTTLE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6405
Practice Address - Country:US
Practice Address - Phone:941-927-4888
Practice Address - Fax:941-927-5808
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062095207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0205070OtherUHC
FL14953OtherBLUE CROSS BLUE SHIELD FL
FL370374600Medicaid
FL625216OtherAETNA
FL7529109001OtherCIGNA
FL14953Medicare ID - Type Unspecified
FL7529109001OtherCIGNA