Organization
MOHAMMAD ALI FAISAL, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMAD ALI FAISAL M.D. (PRESIDENT)
(386) 758-5985
Entity
Organization
Contact information
Practice address
1283 SW STATE ROAD 47, SUITE 104, LAKE CITY, FL 32025-0490
(386) 758-5985
(386) 758-5987
Mailing address
PO BOX 3009, LAKE CITY, FL 32056-3009
(386) 758-5985
(386) 758-5987
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME58587
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21142
BCBS
FL
05
—
251378100
—
FL
Enumeration date
04/18/2006
Last updated
05/19/2014
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