Provider Demographics
NPI:1861466641
Name:AHMED, BASHIR (MD)
Entity Type:Individual
Prefix:
First Name:BASHIR
Middle Name:
Last Name:AHMED
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 1:7901 JAMES ISLAND TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7379
Mailing Address - Country:US
Mailing Address - Phone:904-388-2540
Mailing Address - Fax:904-387-6800
Practice Address - Street 1:2149 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4418
Practice Address - Country:US
Practice Address - Phone:904-384-2525
Practice Address - Fax:904-389-4135
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274585200Medicaid
FL28604AMedicare ID - Type UnspecifiedMEDICARE
FL28604ZMedicare PIN
FL274585200Medicaid