Healthcare Provider Details

I. General information

NPI: 1992122170
Provider Name (Legal Business Name): NADIA BAKOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6477 103RD ST
JACKSONVILLE FL
32210-7129
US

IV. Provider business mailing address

6477 103RD ST
JACKSONVILLE FL
32210-7129
US

V. Phone/Fax

Practice location:
  • Phone: 904-613-4181
  • Fax:
Mailing address:
  • Phone: 904-613-4181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME131303
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: