Provider Demographics
NPI:1467612671
Name:EID, AMALIE FAOUZI (MD)
Entity Type:Individual
Prefix:
First Name:AMALIE
Middle Name:FAOUZI
Last Name:EID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMELY
Other - Middle Name:FAOUZI
Other - Last Name:EID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-296-5691
Mailing Address - Fax:
Practice Address - Street 1:4205 BELFORT RD STE 2005
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5876
Practice Address - Country:US
Practice Address - Phone:904-450-6140
Practice Address - Fax:904-450-6137
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11013150A207R00000X
FLME111620207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005581400Medicaid
FL14K64OtherBCBS
GA003124361AMedicaid
FL005581400Medicaid