Provider Demographics
NPI:1265429823
Name:LATIF, SAJID (MD)
Entity type:Individual
Prefix:DR
First Name:SAJID
Middle Name:
Last Name:LATIF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4641 S CLYDE MORRIS BLVD
Mailing Address - Street 2:UNIT 201
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-6003
Mailing Address - Country:US
Mailing Address - Phone:386-322-6340
Mailing Address - Fax:386-322-6212
Practice Address - Street 1:4641 S CLYDE MORRIS BLVD
Practice Address - Street 2:UNIT 201
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-6003
Practice Address - Country:US
Practice Address - Phone:386-322-6340
Practice Address - Fax:386-322-6212
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0070777207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253569600Medicaid
FL262829832OtherHUMANA
FLN448386OtherHEALTHEASE
FLP936412OtherOPTIMUM
390006858OtherRAILROAD MEDICARE
005982OtherFLORIDA HEALTH CARE PLAN
FL42321OtherBCBS
FL1916107OtherAETNA
FLN448386OtherHEALTHEASE
FL262829832OtherHUMANA