=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184627390
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHRAF S ELSAKR M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2005
-----------------------------------------------------
Last Update Date | 09/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 840 DUNLAWTON AVE STE A
-----------------------------------------------------
City | PORT ORANGE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32127-4224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-304-9672
-----------------------------------------------------
Fax | 386-304-9673
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 840 DUNLAWTON AVE STE A
-----------------------------------------------------
City | PORT ORANGE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32127-4224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-304-9672
-----------------------------------------------------
Fax | 386-304-9673
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | ME0070981
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------