Organization
DIAGNOSTIC IMAGING PA
Active
Organization
DIAGNOSTIC IMAGING PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAHID M NASIR MD (PRESIDENT)
(904) 629-6733
Entity
Organization
Contact information
Practice address
1052 PONTE VEDRA BLVD, PONTE VEDRA BEACH, FL 32082-4015
(904) 551-0703
(904) 551-0709
Mailing address
130 CORRIDOR RD UNIT 428, PONTE VEDRA BEACH, FL 32004-7718
(904) 551-0703
(904) 551-0709
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000703600
—
FL
Enumeration date
12/29/2008
Last updated
10/07/2021
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