Provider Demographics
NPI:1265675219
Name:ASHFAQ KUDIA, M.D., P.A.
Entity Type:Organization
Organization Name:ASHFAQ KUDIA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FURRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUDIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-461-9330
Mailing Address - Street 1:PO BOX 3208
Mailing Address - Street 2:SUITE 302A
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-3208
Mailing Address - Country:US
Mailing Address - Phone:904-461-9330
Mailing Address - Fax:904-461-9331
Practice Address - Street 1:1301 PLANTATION ISLAND DR S
Practice Address - Street 2:SUITE 302A
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3108
Practice Address - Country:US
Practice Address - Phone:904-461-9330
Practice Address - Fax:904-461-9331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068850261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28138OtherBC/BS
FL379026600Medicaid
FL379026600Medicaid
FL28138AMedicare PIN