MEDICARE: DR. ABDUL A QAZIZADA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME94587	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME94587	OTHER	FL	MEDICAL LICENSE
2	53107	OTHER	FL	BCBS FL PROVIDER #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124044672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABDUL A QAZIZADA M.D.

Provider Business Mailing Address
First Line	:	330 CORPORATE WAY STE 200
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-6214
Country	:	US
Telephone Number	:	904-282-6331
Fax Number	:	904-866-4818

Provider Business Practice Location Address
First Line	:	1689 EAGLE HARBOR PKWY STE A
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-4817
Country	:	US
Telephone Number	:	904-269-1366
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	05/19/2026

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