Provider Demographics
NPI:1861444879
Name:ABDULLAH, SHUKRI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHUKRI
Middle Name:
Last Name:ABDULLAH
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 1:653 W 23RD STREET
Mailing Address - Street 2:PMB 244
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3992
Mailing Address - Country:US
Mailing Address - Phone:850-215-2337
Mailing Address - Fax:
Practice Address - Street 1:1200 RIVERPLACE BLVD
Practice Address - Street 2:SUITE: 620
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-9046
Practice Address - Country:US
Practice Address - Phone:904-396-6620
Practice Address - Fax:904-396-6528
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108424207R00000X
CAA96702208M00000X
MO2018042049207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA96702OtherMEDICAL LICENSE
CA0-608-847-0OtherECFMG
CA00A967020Medicaid
CA0-608-847-0OtherECFMG
CAA96702OtherMEDICAL LICENSE