Provider Demographics
NPI:1245335470
Name:BARAKZOY, AHMAD SHAH (MD)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:SHAH
Last Name:BARAKZOY
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 1:2035 PROFESSIONAL CENTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4462
Mailing Address - Country:US
Mailing Address - Phone:904-579-3578
Mailing Address - Fax:904-375-8568
Practice Address - Street 1:2035 PROFESSIONAL CENTER DR STE A
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4462
Practice Address - Country:US
Practice Address - Phone:904-579-3578
Practice Address - Fax:904-375-8568
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94217207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273911900Medicaid
FL273911900Medicaid
FL29554WMedicare Oscar/Certification
FLEI733AMedicare PIN
FLEI733AMedicare PIN