Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME95557 | FL |
NPI | 1003841081 |
---|---|
Provider Name | Ejaz Ahmed |
First Address | Daytona Beach, FL 32114-2730 |
Second Address | Daytona Beach, FL 32114-2730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 22/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020641400 | (05) | FL |
AJ546R | (02) | FL |