Healthcare Provider Details

I. General information

NPI: 1851512990
Provider Name (Legal Business Name): ZEESHAN SARWAR AZIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 S 18TH ST SUITE 340
FERNANDINA BEACH FL
32034-4785
US

IV. Provider business mailing address

PO BOX 41516
JACKSONVILLE FL
32203-1516
US

V. Phone/Fax

Practice location:
  • Phone: 904-775-5957
  • Fax: 904-844-2149
Mailing address:
  • Phone: 904-202-5111
  • Fax: 904-391-5836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberME114237
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: