Healthcare Provider Details

I. General information

NPI: 1073591269
Provider Name (Legal Business Name): ENAS G. ISKANDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ENAS GERGES

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1688 W GRANADA BLVD STE 2A1
ORMOND BEACH FL
32174
US

IV. Provider business mailing address

303 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2709
US

V. Phone/Fax

Practice location:
  • Phone: 386-425-4466
  • Fax: 386-425-4461
Mailing address:
  • Phone: 386-226-4590
  • Fax: 386-226-3371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0057495
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME7495
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME57495
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: