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Individual

DR. ELMUTAZ M ELTAHIR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
9981 S HEALTHPARK DR, FORT MYERS, FL 33908-3618
(239) 343-2052
(239) 343-5348
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-2052
(239) 343-5348

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101263961
VA
207R00000X
Internal Medicine Physician
48498
CO
207R00000X
Internal Medicine Physician
48616-020
WI
208M00000X
Hospitalist Physician
0101263961
VA
208M00000X
Hospitalist Physician
DR.0048498
CO
208M00000X
Hospitalist Physician
Primary
ME167080
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
020625
KAISER COMMERCIAL NUMBER
CO
05
122019900
FL
05
1982723821
VA
01
48616-020
WI LICENSE NUMBER
WI
05
62380851
CO
Enumeration date
03/29/2007
Last updated
08/09/2024
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