Healthcare Provider Details

I. General information

NPI: 1053247510
Provider Name (Legal Business Name): AMMAAR JAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 GLADES RD
BOCA RATON FL
33431-6424
US

IV. Provider business mailing address

777 GLADES RD
BOCA RATON FL
33431-6424
US

V. Phone/Fax

Practice location:
  • Phone: 561-297-4828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTRN46509
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: