Provider Demographics
NPI:1780675108
Name:RAHIM, ABDUR (MD)
Entity Type:Individual
Prefix:
First Name:ABDUR
Middle Name:
Last Name:RAHIM
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 1:2055 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4421
Mailing Address - Country:US
Mailing Address - Phone:727-842-9486
Mailing Address - Fax:727-849-2623
Practice Address - Street 1:2035 LITTLE RD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4421
Practice Address - Country:US
Practice Address - Phone:727-842-9486
Practice Address - Fax:727-849-2623
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0027075207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035443100Medicaid
FL060009003OtherRAILROAD MEDICARE
D65994Medicare UPIN
FL035443100Medicaid