Provider Demographics
NPI:1477538593
Name:AFFAN, ASHRAF ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHRAF
Middle Name:ALI
Last Name:AFFAN
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 1:12062 LONDON LAKE DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-3317
Mailing Address - Country:US
Mailing Address - Phone:904-880-0062
Mailing Address - Fax:
Practice Address - Street 1:1121 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-3446
Practice Address - Country:US
Practice Address - Phone:904-242-4220
Practice Address - Fax:904-242-4221
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 86016208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics