Provider Demographics
NPI:1053310342
Name:ABUSUWA, JAMAL A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMAL
Middle Name:A
Last Name:ABUSUWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:220 ALAFAYA WOODS BLVD
Mailing Address - Street 2:STE: 1000
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6212
Mailing Address - Country:US
Mailing Address - Phone:407-542-7335
Mailing Address - Fax:407-542-7338
Practice Address - Street 1:220 ALAFAYA WOODS BLVD
Practice Address - Street 2:STE: 1000
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6212
Practice Address - Country:US
Practice Address - Phone:407-542-7335
Practice Address - Fax:407-542-7338
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME87949207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268174900Medicaid
FL43010OtherBCBS
FL004838300Medicaid
FLGF041AMedicare PIN
FLI14889Medicare UPIN