Provider Demographics
NPI:1801989017
Name:HABAL, MUTAZ B (MD)
Entity type:Individual
Prefix:DR
First Name:MUTAZ
Middle Name:B
Last Name:HABAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:205 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3600
Mailing Address - Country:US
Mailing Address - Phone:813-238-0409
Mailing Address - Fax:813-238-1119
Practice Address - Street 1:205 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3600
Practice Address - Country:US
Practice Address - Phone:813-238-0409
Practice Address - Fax:813-238-1119
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME21292208200000X, 2082S0099X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL202540OtherAMERIGROUP
FL592023224OtherHUMANA
FL68008OtherBLUE CROSS & BLUE SIHELD
FL01047OtherSTAYWELL-WELLCARE-HEALTHEASE
FL1247218OtherCIGNA
FL01047OtherSTAYWELL-WELLCARE-HEALTHEASE
FL68008OtherBLUE CROSS & BLUE SIHELD