Healthcare Provider Details

I. General information

NPI: 1407694854
Provider Name (Legal Business Name): DR. ANAS JASSIM ALJARAD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR # D2-27
GAINESVILLE FL
32610-4556
US

IV. Provider business mailing address

2370 SW ARCHER RD APT 16
GAINESVILLE FL
32608-1055
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7957
  • Fax:
Mailing address:
  • Phone: 352-222-5769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDRPM2788
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: