Basic Information
| Provider Information | |||||||||
| NPI: | 1871551580 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAMZA | ||||||||
| FirstName: | MAGED | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 705 WELLS RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320732982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042826331 | ||||||||
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| Practice Location | |||||||||
| Address1: | 404 NW HALL OF FAME DR | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320554833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862870410 | ||||||||
| FaxNumber: | 3862870411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2006 | ||||||||
| LastUpdateDate: | 07/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0101228976 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 0101228976 | VA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.