Provider Demographics
NPI:1033272364
Name:MA, XAI (MD)
Entity Type:Individual
Prefix:DR
First Name:XAI
Middle Name:
Last Name:MA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 NE WALDO RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-3900
Mailing Address - Country:US
Mailing Address - Phone:352-955-5540
Mailing Address - Fax:352-373-5326
Practice Address - Street 1:1621 NE WALDO RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3900
Practice Address - Country:US
Practice Address - Phone:352-955-5540
Practice Address - Fax:352-373-5326
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD21390Medicare UPIN
FL15984Medicare ID - Type Unspecified