Healthcare Provider Details

I. General information

NPI: 1477538593
Provider Name (Legal Business Name): ASHRAF ALI AFFAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 01/18/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13241 BARTRAM PARK BLVD UNIT 209
JACKSONVILLE FL
32258-5233
US

IV. Provider business mailing address

13241 BARTRAM PARK BLVD UNIT 209
JACKSONVILLE FL
32258-5233
US

V. Phone/Fax

Practice location:
  • Phone: 904-616-2772
  • Fax:
Mailing address:
  • Phone: 904-616-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 86016
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: