Provider Demographics
NPI:1558303818
Name:WASEEM, ZAHOOR A (MD)
Entity Type:Individual
Prefix:
First Name:ZAHOOR
Middle Name:A
Last Name:WASEEM
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 38
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-0038
Mailing Address - Country:US
Mailing Address - Phone:386-362-6405
Mailing Address - Fax:386-362-6403
Practice Address - Street 1:609 5TH ST SW
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-2216
Practice Address - Country:US
Practice Address - Phone:386-362-6405
Practice Address - Fax:386-362-6403
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0073901207R00000X
FLME73901207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108993OtherRURAL HEALTH CLINIC
FL253662500Medicaid
FLE0381YMedicare ID - Type UnspecifiedSHAFA CLINIC
FLE0381EMedicare PIN
G65979Medicare UPIN
FLE0381BMedicare ID - Type Unspecified
FL253662500Medicaid