Provider Demographics
NPI:1225045461
Name:RAHMAN, ATAUR (MD)
Entity Type:Individual
Prefix:
First Name:ATAUR
Middle Name:
Last Name:RAHMAN
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 1:905 BEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1705
Mailing Address - Country:US
Mailing Address - Phone:386-767-9000
Mailing Address - Fax:386-767-3761
Practice Address - Street 1:905 BEVILLE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1705
Practice Address - Country:US
Practice Address - Phone:386-767-9000
Practice Address - Fax:386-767-9000
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01876388Medicaid
NYG77955Medicare UPIN
NY01876388Medicaid