Individual
IBRAHIM FAHDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1681 EAGLE HARBOR PKWY STE 101, FLEMING ISLAND, FL 32003
(904) 644-0092
(904) 644-0099
Mailing address
PO BOX 551308, JACKSONVILLE, FL 32255-1308
(904) 622-9040
(904) 309-5691
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME113759
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006622500
—
FL
05
—
1588754055
—
AL
01
—
P00165055
RAILROAD MEDICARE
AR
Enumeration date
10/13/2006
Last updated
07/12/2018
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