Healthcare Provider Details

I. General information

NPI: 1215256888
Provider Name (Legal Business Name): ANAS AL YAZJI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6484 FORT CAROLINE RD
JACKSONVILLE FL
32277-2042
US

IV. Provider business mailing address

6484 FORT CAROLINE RD
JACKSONVILLE FL
32277-2042
US

V. Phone/Fax

Practice location:
  • Phone: 904-744-7300
  • Fax: 904-722-4271
Mailing address:
  • Phone: 904-744-7300
  • Fax: 904-722-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME115013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: