Healthcare Provider Details

I. General information

NPI: 1255315875
Provider Name (Legal Business Name): NAJA R NADDAF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1689 EAGLE HARBOR PKWY E SUITE A
ORANGE PARK FL
32003-4817
US

IV. Provider business mailing address

1689 EAGLE HARBOR PKWY E SUITE A
ORANGE PARK FL
32003-4817
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-1366
  • Fax: 904-264-9750
Mailing address:
  • Phone: 904-269-1366
  • Fax: 904-264-9750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME90385
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: