Provider Demographics
NPI:1851512990
Name:AZIZ, ZEESHAN SARWAR (MD)
Entity Type:Individual
Prefix:
First Name:ZEESHAN
Middle Name:SARWAR
Last Name:AZIZ
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 41516
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-1516
Mailing Address - Country:US
Mailing Address - Phone:904-202-5111
Mailing Address - Fax:904-391-5836
Practice Address - Street 1:1348 S 18TH ST
Practice Address - Street 2:SUITE 340
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4785
Practice Address - Country:US
Practice Address - Phone:904-775-5957
Practice Address - Fax:904-844-2149
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114237207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01699168OtherRR MEDICARE
FL008601100Medicaid
FL14Q86OtherFL BLUE
FLHF553XMedicare PIN
FLHF553ZMedicare PIN