Provider Demographics
NPI:1316101264
Name:ABDURRAQEEB, OBAYDAH AHMAD (DO)
Entity type:Individual
Prefix:
First Name:OBAYDAH
Middle Name:AHMAD
Last Name:ABDURRAQEEB
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 W COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33351-4325
Mailing Address - Country:US
Mailing Address - Phone:954-475-5500
Mailing Address - Fax:954-625-8771
Practice Address - Street 1:9800 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33351-4325
Practice Address - Country:US
Practice Address - Phone:954-475-5500
Practice Address - Fax:954-625-8771
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS17282207Q00000X
TNDO2182207Q00000X
FLOS11259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS17282OtherMEDICAL LICENSE
TN3373352OtherMEDICARE GRP UFP
TN3373352OtherMEDICAID GRP UFP
FLOS11259OtherMEDICAL LICENSE
TN3373352OtherMEDICARE GRP UFP