Provider Demographics
NPI:1083901177
Name:AFSHAR, ALI REZA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:REZA
Last Name:AFSHAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6900 TAVISTOCK LAKES BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7592
Mailing Address - Country:US
Mailing Address - Phone:904-745-3618
Mailing Address - Fax:904-722-4271
Practice Address - Street 1:4565 US HIGHWAY 17 STE 106
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4822
Practice Address - Country:US
Practice Address - Phone:904-269-4559
Practice Address - Fax:904-269-4597
Is Sole Proprietor?:No
Enumeration Date:2011-07-09
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301111119207Q00000X
FLME129267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine