Provider Demographics
NPI:1730243874
Name:WAZNI, GAMAL M (MD)
Entity type:Individual
Prefix:DR
First Name:GAMAL
Middle Name:M
Last Name:WAZNI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3810 NORTHDALE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1871
Mailing Address - Country:US
Mailing Address - Phone:813-961-1331
Mailing Address - Fax:888-850-8316
Practice Address - Street 1:3810 NORTHDALE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1871
Practice Address - Country:US
Practice Address - Phone:813-961-1331
Practice Address - Fax:888-850-8316
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2020-04-15
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Provider Licenses
StateLicense IDTaxonomies
MI4301082006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine