Provider Demographics
NPI:1962842591
Name:AL-ANI, MOHAMMAD AHMAD ZAKI (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:AHMAD ZAKI
Last Name:AL-ANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 100277
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0277
Mailing Address - Country:US
Mailing Address - Phone:352-273-9079
Mailing Address - Fax:352-273-8889
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:ROOM 4102
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-9079
Practice Address - Fax:352-273-8889
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN18580207R00000X
FLME140287207RC0000X, 207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106794100Medicaid