# ABDUL B MIR MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255660775
- **Authorized official:** ABDUL B MIR (OWNER)
- **Authorized official phone:** (850) 682-5174

## Contact information

- **Practice address:** 131 E REDSTONE AVE, SUITE 101, CRESTVIEW, FL 32539-5326
- **Practice address phone:** (850) 682-5174
- **Practice address fax:** (850) 689-3653
- **Mailing address:** 131 E REDSTONE AVE, SUITE 101, CRESTVIEW, FL 32539-5326
- **Mailing address phone:** (850) 682-5174
- **Mailing address fax:** (850) 689-3653

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | ME0032883 | FL | Yes |

## Other

- **Enumeration date:** 12/11/2009
- **Last updated:** 12/11/2009