Healthcare Provider Details

I. General information

NPI: 1275587453
Provider Name (Legal Business Name): AHMED I JAKDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8931 CONFERENCE DR STE 5
FORT MYERS FL
33919-4893
US

IV. Provider business mailing address

8931 CONFERENCE DR STE 5
FORT MYERS FL
33919-4893
US

V. Phone/Fax

Practice location:
  • Phone: 239-278-0100
  • Fax: 740-383-8517
Mailing address:
  • Phone: 239-278-0100
  • Fax: 937-619-4231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35086772
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: