Healthcare Provider Details

I. General information

NPI: 1881706828
Provider Name (Legal Business Name): A.H NEZAMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 SOUTHPOINT PKWY STE 503
JACKSONVILLE FL
32216-6289
US

IV. Provider business mailing address

820 PRUDENTIAL DR SUITE 702
JACKSONVILLE FL
32207-8210
US

V. Phone/Fax

Practice location:
  • Phone: 904-399-5061
  • Fax:
Mailing address:
  • Phone: 904-399-5061
  • Fax: 904-399-5062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number038905
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: