Healthcare Provider Details

I. General information

NPI: 1376504324
Provider Name (Legal Business Name): NAZIM MERCHANT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14015 EGRET TOWER DR
ORLANDO FL
32837-6197
US

IV. Provider business mailing address

14015 EGRET TOWER DR
ORLANDO FL
32837-6197
US

V. Phone/Fax

Practice location:
  • Phone: 407-447-7100
  • Fax: 407-447-6100
Mailing address:
  • Phone: 407-447-7100
  • Fax: 407-447-6100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME71136
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: