1679769293 NPI number — ASHRAF ELSAKR, M.D., P.A.,

Table of content: (NPI 1851962658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679769293 NPI number — ASHRAF ELSAKR, M.D., P.A.,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASHRAF ELSAKR, M.D., P.A.,
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679769293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
840 DUNLAWTON AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
PORT ORANGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32127-4223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-304-9672
Provider Business Mailing Address Fax Number:
386-304-9673

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
840 DUNLAWTON AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PORT ORANGE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32127-4223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-304-9672
Provider Business Practice Location Address Fax Number:
386-304-9673
Provider Enumeration Date:
09/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ELSAKR
Authorized Official First Name:
ASHRAF
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
386-304-9672

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  ME70981 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 250345000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com