Healthcare Provider Details

I. General information

NPI: 1528013042
Provider Name (Legal Business Name): ATIF ABUBAKER ABDALLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7603 LEM TURNER RD
JACKSONVILLE FL
32208-3252
US

IV. Provider business mailing address

PO BOX 550789
JACKSONVILLE FL
32255-0789
US

V. Phone/Fax

Practice location:
  • Phone: 904-329-3336
  • Fax: 904-517-8919
Mailing address:
  • Phone: 904-329-3336
  • Fax: 904-517-8919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301080503
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME128260
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: