Individual
ANIS A. AHMADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
216 SOUTHPARK CIR E, SAINT AUGUSTINE, FL 32086-5135
(904) 824-6108
(904) 823-9613
Mailing address
216 SOUTHPARK CIR E, SAINT AUGUSTINE, FL 32086-5135
(904) 824-6108
(904) 823-9613
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME102708
FL
207RG0100X
Gastroenterology Physician
Primary
ME102708
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000732600
—
FL
Enumeration date
11/13/2006
Last updated
06/15/2011
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