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General NPI Number Information
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NPI Number | 1164767737
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Entity Type | Organization
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Legal Business Name | NASG CARE, LLC
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Dates
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Enumeration Date | 12/07/2012
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 800 PRUDENTIAL DR
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8202
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Country | US
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Telephone | 904-625-8365
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Fax |
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Provider Business Mailing Address
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Address Line | 11744 GLACIER BAY DR
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City | JACKSONVILLE
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State | FL
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Zip | 32256-2988
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Country | US
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Telephone | 904-625-8365
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. GASIM ELSHAZALI
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Credential |
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Telephone | 904-625-8365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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