Healthcare Provider Details

I. General information

NPI: 1720361835
Provider Name (Legal Business Name): MALIK ALI DAWOUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2011
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3607
US

IV. Provider business mailing address

PO BOX 100374
GAINESVILLE FL
32610-0191
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0291
  • Fax: 352-265-0279
Mailing address:
  • Phone: 352-265-0291
  • Fax: 352-265-0279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberC1-0013542
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME143300
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberE-9826
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberME143300
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: