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Individual

DR. EJAZ YOUSEF

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
807 CHILDRENS WAY, NEMOURS CHILDRENS CLINIC, JACKSONVILLE, JACKSONVILLE, FL 32207-8426
(904) 697-3600
(904) 697-3455
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPARTMENT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-4945

Taxonomy

Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
56579
WI
2080P0201X
Pediatric Allergy/Immunology Physician
56579
WI
2080P0201X
Pediatric Allergy/Immunology Physician
C10006135
DE
2080P0201X
Pediatric Allergy/Immunology Physician
Primary
ME120908
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001680789
PA
05
0033153424B
GA
05
013670600
FL
05
1205996402
WI
05
64050859
KY
05
8003700
NJ
05
8301018
MD
Enumeration date
12/11/2006
Last updated
05/06/2015
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