Provider Demographics
NPI:1487684171
Name:ZULFIQAR, HASSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:
Last Name:ZULFIQAR
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 1:1690 DUNLAWTON AVE
Mailing Address - Street 2:SUITE # 210
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-8980
Mailing Address - Country:US
Mailing Address - Phone:386-763-4920
Mailing Address - Fax:386-763-4939
Practice Address - Street 1:1690 DUNLAWTON AVE
Practice Address - Street 2:SUITE # 210
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-8980
Practice Address - Country:US
Practice Address - Phone:386-763-4920
Practice Address - Fax:386-763-4939
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78417207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46913OtherBCBS
FL262929100Medicaid
FL46913OtherBCBS