Individual
DR. ABDUL KHALIL WALLIZADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2051 PROFESSIONAL CENTER DRIVE, ORANGE PARK, FL 32073-4461
(904) 276-0005
(855) 600-3475
Mailing address
2051 PROFESSIONAL CENTER DRIVE, ORANGE PARK, FL 32073-4461
(904) 276-0005
(855) 600-3475
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME0067026
FL
208000000X
Pediatrics Physician
ME67026
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376381100
—
FL
Enumeration date
06/27/2008
Last updated
01/10/2025
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