Provider Demographics
NPI:1316969595
Name:ALKHALIL, BACHAR (MD)
Entity type:Individual
Prefix:
First Name:BACHAR
Middle Name:
Last Name:ALKHALIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SHIRCLIFF WAY
Mailing Address - Street 2:SUITE 700 DEPAUL BLDG
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204
Mailing Address - Country:US
Mailing Address - Phone:904-389-5333
Mailing Address - Fax:904-389-5332
Practice Address - Street 1:1563 KINGSLEY AVENUE
Practice Address - Street 2:SUITE 106
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073
Practice Address - Country:US
Practice Address - Phone:904-389-5333
Practice Address - Fax:904-389-5332
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100758208M00000X, 207RN0300X, 207RN0300X
GA056004208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL281309200Medicaid
FL281309200Medicaid
FLAK126ZMedicare PIN
FLAK126YMedicare PIN
GA711217641DMedicaid
GA11SCHJNMedicare PIN
FLAK126ZMedicare PIN
GA11SCFPLMedicare ID - Type Unspecified
FLAK126YMedicare PIN