Individual
DR. SYED WASIM ALI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
236 SOUTHPARK CIRCLE EAST, ST AUGUSTINE, FL 32086
(904) 824-5386
(904) 824-5387
Mailing address
P O BOX 1960, US HIGHWAY 1 SOUTH STE 20, ST AUGUSTINE, FL 32086
(904) 824-5386
(904) 824-5387
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
ME0068402
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250283600
—
FL
01
—
28877
BLUE CROSS BLUE SHEILD ID
FL
01
—
5438521
AETNA PROVIDER #
FL
01
—
593463106
TAX IDENTIFICATION NUMBER
FL
Enumeration date
06/21/2005
Last updated
06/17/2008
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