Healthcare Provider Details

I. General information

NPI: 1023013497
Provider Name (Legal Business Name): YOUSIF ABUBAKR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5742 BOOTH RD SUITE A
JACKSONVILLE FL
32207-5982
US

IV. Provider business mailing address

7751 BELFORT PKWY STE 350
JACKSONVILLE FL
32256-6951
US

V. Phone/Fax

Practice location:
  • Phone: 904-739-7779
  • Fax: 904-739-7771
Mailing address:
  • Phone: 904-363-2113
  • Fax: 904-363-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME 70677
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: