Provider Demographics
NPI:1881700698
Name:DEEB, WASIM E (MD)
Entity type:Individual
Prefix:DR
First Name:WASIM
Middle Name:E
Last Name:DEEB
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 1:8837 GOODBYS EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4605
Mailing Address - Country:US
Mailing Address - Phone:904-990-0555
Mailing Address - Fax:904-990-0551
Practice Address - Street 1:8837 GOODBYS EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217
Practice Address - Country:US
Practice Address - Phone:904-990-0555
Practice Address - Fax:904-990-0551
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102044207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0003365-00Medicaid
FLP0068261OtherRAILROAD MEDICARE
FLAM873ZMedicare PIN