Individual
DR. HASSAN TAVAKKOLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
8051 W. SUNRISE BLVD, PLANTATION, FL 33322
(954) 474-2900
(954) 474-2901
Mailing address
P.O. BOX 39209, FT. LAUDERDALE, FL 33339
(954) 851-9966
(954) 318-7360
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
OS 6626
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0853300
AETNA
FL
01
—
235914
AVMED
FL
01
—
375397200
MEDICAID
FL
05
—
375397200
—
FL
01
—
650505235
UNITEDHEALTHCARE
FL
01
—
80799
BLUE CROSS BLUE SHIELD
FL
Enumeration date
11/27/2007
Last updated
03/23/2021
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