Provider Demographics
NPI:1528013042
Name:ABDALLA, ATIF ABUBAKER (MD)
Entity Type:Individual
Prefix:
First Name:ATIF
Middle Name:ABUBAKER
Last Name:ABDALLA
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:PO BOX 550789
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32255-0789
Mailing Address - Country:US
Mailing Address - Phone:904-329-3336
Mailing Address - Fax:904-517-8919
Practice Address - Street 1:7603 LEM TURNER RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-3252
Practice Address - Country:US
Practice Address - Phone:904-329-3336
Practice Address - Fax:904-517-8919
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080503207R00000X
FLME128260207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103880100Medicaid