Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | ME0120567 | FL |
N | 2080P0204X | Pediatric Emergency Doctor | ME0120567 | FL |
NPI | 1164861001 |
---|---|
Provider Name | Dr. Mubarak N Abdur-Rahman |
First Address | Jacksonville, FL 32209-6511 |
Second Address | Jacksonville, FL 32209-6511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2013 |
Last Update Date | 28/03/2017 |