MEDICARE: AHMAD YASER ABDULZAHIR

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	207R00000X	Internal Medicine Physician	ME149888	FL
2	207RH0003X	Hematology & Oncology Physician	ME149888	FL
3	207RH0000X	Hematology (Internal Medicine) Physician	MEDPHYSCOM-LIC-16658	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164928107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHMAD YASER ABDULZAHIR

Provider Business Mailing Address
First Line	:	2955 MONTILLA DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-5528
Country	:	US
Telephone Number	:	904-930-8603
Fax Number	:

Provider Business Practice Location Address
First Line	:	2955 MONTILLA DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-5528
Country	:	US
Telephone Number	:	904-930-8603
Fax Number	:

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

Provider Enumeration Date	:	03/30/2018
Last Update Date	:	03/18/2026

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