Provider Demographics
NPI:1760795413
Name:AHMAD S BARAKZOY MD LLC
Entity Type:Organization
Organization Name:AHMAD S BARAKZOY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARAKZOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-579-3578
Mailing Address - Street 1:2035 PROFESSIONAL CENTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4462
Mailing Address - Country:US
Mailing Address - Phone:904-579-3578
Mailing Address - Fax:907-375-8568
Practice Address - Street 1:2035 PROFESSIONAL CENTER DR STE A
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4462
Practice Address - Country:US
Practice Address - Phone:904-579-3578
Practice Address - Fax:904-375-8568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94217207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273911900Medicaid