Provider Demographics
NPI:1740206937
Name:BAHER, ABDALAGANI A (MD)
Entity Type:Individual
Prefix:
First Name:ABDALAGANI
Middle Name:A
Last Name:BAHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ABDALAGANI
Other - Middle Name:A
Other - Last Name:ABAKAR-BAHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-5964
Mailing Address - Fax:
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061927A207R00000X
IN01061927208M00000X
FLME123518207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000491497OtherANTHEM
IN20543OtherPHP
INP00364911OtherRAILROAD MEDICARE
IN3937240010OtherMEDICARE DMEPOS
IN200837130Medicaid
IN069860YYMedicare PIN
INP00364911OtherRAILROAD MEDICARE
IN070860YYMedicare PIN
IN3937240010OtherMEDICARE DMEPOS