Provider Demographics
NPI:1073591269
Name:ISKANDER, ENAS G (MD)
Entity type:Individual
Prefix:DR
First Name:ENAS
Middle Name:G
Last Name:ISKANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ENAS
Other - Middle Name:
Other - Last Name:GERGES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:303 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2709
Mailing Address - Country:US
Mailing Address - Phone:386-226-4590
Mailing Address - Fax:386-226-3371
Practice Address - Street 1:1688 W GRANADA BLVD STE 2A1
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-425-4466
Practice Address - Fax:386-425-4461
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057495208000000X
FLME7495208D00000X
FLME57495208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054122201Medicaid
FL12487OtherBLUE CROSS BLUE SHIELD FL