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NPI Code Detail

MEDICARE: DR. AHMAD OUSSAMA RIFAI M.D.

MEDICARE: DR. AHMAD OUSSAMA RIFAI 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
1207RN0300XNephrology PhysicianME78033FL
2207R00000XInternal Medicine PhysicianME78033FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2390006271OTHERRRB PTAN

General Provider Information

NPI Number : 1396741526
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AHMAD OUSSAMA RIFAI M.D.
Provider Business Mailing Address
First Line : 4205 BELFORT RD STE 4015
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-3623
Country : US
Telephone Number : 904-450-6063
Fax Number : 904-539-4091
Provider Business Practice Location Address
First Line : 615 N BONITA AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32401-3623
Country : US
Telephone Number : 850-769-1511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 07/15/2025

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