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Individual

DR. FATAH ABDUL WALLIZADA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1395 CASSAT AVE, SUITE# 1, JACKSONVILLE, FL 32205-9616
(904) 388-5832
(904) 388-6270
Mailing address
1395 CASSAT AVE, SUITE# 1, JACKSONVILLE, FL 32205-9616
(904) 388-5832
(904) 388-6270

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME0062087
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
371234600
FL
Enumeration date
07/20/2006
Last updated
07/08/2007
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