Provider Demographics
NPI:1881706828
Name:NEZAMI, A.H (MD)
Entity type:Individual
Prefix:DR
First Name:A.H
Middle Name:
Last Name:NEZAMI
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 1:820 PRUDENTIAL DR
Mailing Address - Street 2:SUITE 702
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8210
Mailing Address - Country:US
Mailing Address - Phone:904-399-5061
Mailing Address - Fax:904-399-5062
Practice Address - Street 1:820 PRUDENTIAL DR
Practice Address - Street 2:SUITE 702
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8210
Practice Address - Country:US
Practice Address - Phone:904-399-5061
Practice Address - Fax:904-399-5062
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL038905208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15661Medicare ID - Type UnspecifiedMEDICARE AND BCBS
FLD52688Medicare UPIN