Healthcare Provider Details

I. General information

NPI: 1780675108
Provider Name (Legal Business Name): ABDUR RAHIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 LITTLE RD
TRINITY FL
34655-4421
US

IV. Provider business mailing address

2035 LITTLE RD
TRINITY FL
34655-4421
US

V. Phone/Fax

Practice location:
  • Phone: 727-842-9486
  • Fax: 727-849-2623
Mailing address:
  • Phone: 727-842-9486
  • Fax: 727-372-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME0027075
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0027075
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: