MEDICARE: DR. RUBINA AZAM 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	208000000X	Pediatrics Physician	ME91470	FL

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
2	50231	OTHER	FL	BCBS OF FLORIDA

General Provider Information

NPI Number	:	1689639114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBINA AZAM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 551269
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32255-1269
Country	:	US
Telephone Number	:	904-853-1763
Fax Number	:	850-248-2469

Provider Business Practice Location Address
First Line	:	6789 SOUTHPOINT PKWY STE 202
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-8206
Country	:	US
Telephone Number	:	850-628-9240
Fax Number	:	850-248-2469

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	11/05/2025

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