1871864561 NPI number — DR. SEIED ALI SAFI M.D.

Table of content: SARAH WATSON (NPI 1013251933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871864561 NPI number — DR. SEIED ALI SAFI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAFI
Provider First Name:
SEIED
Provider Middle Name:
ALI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1871864561
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9770 OLD BAYMEADOWS RD
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32256-7909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-564-2700
Provider Business Mailing Address Fax Number:
904-564-2800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9770 OLD BAYMEADOWS RD
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32256-7909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-564-2700
Provider Business Practice Location Address Fax Number:
904-564-2800
Provider Enumeration Date:
01/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  ME54100 , 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: 191457 . This is a "WELLCARE/HEALTHEASE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 08314 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 061396700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 209183 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 593442982 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 593442982 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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