Provider Demographics
NPI:1700950474
Name:CHOWDHURY, SHAMSUR RAHMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAMSUR
Middle Name:RAHMAN
Last Name:CHOWDHURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MOHAMMED
Other - Middle Name:SHAMSUR R
Other - Last Name:CHOWDHURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 44047
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4047
Mailing Address - Country:US
Mailing Address - Phone:904-376-4083
Mailing Address - Fax:904-391-5075
Practice Address - Street 1:836 PRUDENTIAL DR STE 802
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8335
Practice Address - Country:US
Practice Address - Phone:904-202-8290
Practice Address - Fax:904-202-8171
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1136892080P0203X
VA01012423382080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine