Provider Demographics
NPI:1184627390
Name:ELSAKR, ASHRAF S (MD)
Entity type:Individual
Prefix:DR
First Name:ASHRAF
Middle Name:S
Last Name:ELSAKR
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 1:840 DUNLAWTON AVE
Mailing Address - Street 2:STE A
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4224
Mailing Address - Country:US
Mailing Address - Phone:386-304-9672
Mailing Address - Fax:386-304-9673
Practice Address - Street 1:840 DUNLAWTON AVE
Practice Address - Street 2:STE A
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4224
Practice Address - Country:US
Practice Address - Phone:386-304-9672
Practice Address - Fax:386-304-9673
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-09-01
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
FLME0070981207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250345000Medicaid
FL31428WMedicare ID - Type Unspecified
FL250345000Medicaid