Individual
DR. QAHTAN A ABDULFATTAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11323 CORTEZ BLVD, BROOKSVILLE, FL 34613-5407
(352) 596-8344
(352) 597-2898
Mailing address
14690 SPRING HILL DR, SUITE 100 ATTN:CREDENTIALING, SPRING HILL, FL 34609-8102
(352) 799-0046
(352) 606-2857
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
ME92671
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000238700
—
FL
01
—
03396
BCBS OF FL
FL
01
—
311869
AVMED
FL
01
—
316584
WELLCARE
FL
01
—
P01426390
RAILROAD MCR LINKED TO GRP#DR6927
FL
Enumeration date
08/07/2006
Last updated
07/21/2022
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