Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | ME93391 | FL |
N | 208000000X | Pediatrician | ME93391 | FL |
N | 2080P0204X | Pediatric Emergency Doctor | ME93391 | FL |
NPI | 1104802305 |
---|---|
Provider Name | Dr. Ashik Nisar Ahmad |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33908-3618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 11/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
274236500 | (05) | FL |
29462 | BCBS (01) | FL |