Provider Demographics
NPI:1750341236
Name:AFZAL, AJAZ (MD)
Entity type:Individual
Prefix:
First Name:AJAZ
Middle Name:
Last Name:AFZAL
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 1:1032 MANN ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4121
Mailing Address - Country:US
Mailing Address - Phone:407-518-7277
Mailing Address - Fax:407-518-7280
Practice Address - Street 1:1032 MANN STREET
Practice Address - Street 2:OAK MEDICAL PLAZA 1
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741
Practice Address - Country:US
Practice Address - Phone:407-518-7277
Practice Address - Fax:407-518-7280
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95168207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBCBS 41739OtherBCBS NUMBER
FLBCBS 41739OtherBCBS NUMBER