Healthcare Provider Details

I. General information

NPI: 1083024715
Provider Name (Legal Business Name): REHAN MOHAMMED NASEEMUDDIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 PRUDENTIAL DR STE 801
JACKSONVILLE FL
32207-8258
US

IV. Provider business mailing address

4800 BELFORT RD
JACKSONVILLE FL
32256-6004
US

V. Phone/Fax

Practice location:
  • Phone: 904-288-0433
  • Fax: 904-288-8996
Mailing address:
  • Phone: 904-483-5826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME144454
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: