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General NPI Number Information
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NPI Number | 1245636042
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Entity Type | Organization
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Legal Business Name | DR EJAZ AHMED MD PA
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Dates
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Enumeration Date | 11/06/2014
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 405 NORTH CLYDE MORRIS BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2730
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Country | US
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Telephone | 386-235-8731
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Fax | 386-269-9555
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Provider Business Mailing Address
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Address Line | 3848 CALLIOPE AVE
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City | PORT ORANGE
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State | FL
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Zip | 32129-6025
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Country | US
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Telephone | 386-235-8731
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Fax | 386-269-9555
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EJAZ AHMED
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Credential | MD
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Telephone | 386-235-8731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME95557
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License Number State | FL
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