Provider Demographics
NPI:1841301116
Name:QUDDUS, FAUZIA F (MD)
Entity type:Individual
Prefix:MS
First Name:FAUZIA
Middle Name:F
Last Name:QUDDUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15465 OAK LN
Mailing Address - Street 2:SUITE 100-F
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-2663
Mailing Address - Country:US
Mailing Address - Phone:228-832-0414
Mailing Address - Fax:228-832-8227
Practice Address - Street 1:15465 OAK LN
Practice Address - Street 2:SUITE 100-F
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2663
Practice Address - Country:US
Practice Address - Phone:228-832-0414
Practice Address - Fax:228-832-8227
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS14692208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115992Medicaid