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General NPI Number Information
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NPI Number | 1689639114
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Entity Type | Individual
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Provider Name | RUBINA AZAM M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 6789 SOUTHPOINT PKWY STE 202
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City | JACKSONVILLE
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State | FL
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Zip | 32216-8206
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Country | US
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Telephone | 850-628-9240
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Fax | 850-248-2469
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Provider Business Mailing Address
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Address Line | PO BOX 551269
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City | JACKSONVILLE
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State | FL
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Zip | 32255-1269
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Country | US
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Telephone | 904-853-1763
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Fax | 850-248-2469
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME91470
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License Number State | FL
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