Healthcare Provider Details

I. General information

NPI: 1760006001
Provider Name (Legal Business Name): AVESAHMED BUKHARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 BAY PINES BLVD BAY PINES
BAY PINES FL
33744-8200
US

IV. Provider business mailing address

10000 BAY PINES BLVD BAY PINES
BAYPINES FL
33744
US

V. Phone/Fax

Practice location:
  • Phone: 813-205-2767
  • Fax:
Mailing address:
  • Phone: 727-398-6661
  • Fax: 727-398-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-16790
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: