Provider Demographics
NPI:1083024715
Name:NASEEMUDDIN, REHAN MOHAMMED (MD)
Entity Type:Individual
Prefix:DR
First Name:REHAN
Middle Name:MOHAMMED
Last Name:NASEEMUDDIN
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 1:4800 BELFORT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6004
Mailing Address - Country:US
Mailing Address - Phone:904-483-5826
Mailing Address - Fax:
Practice Address - Street 1:836 PRUDENTIAL DR STE 801
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8258
Practice Address - Country:US
Practice Address - Phone:904-288-0433
Practice Address - Fax:904-288-8996
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME144454207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107373200Medicaid