Provider Demographics
NPI:1588903207
Name:ABDALLA, AZA M (MD)
Entity type:Individual
Prefix:
First Name:AZA
Middle Name:M
Last Name:ABDALLA
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1608 SE 3RD AVE
Mailing Address - Street 2:THIRD FLOOR CBO/PBS
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2564
Mailing Address - Country:US
Mailing Address - Phone:954-847-4273
Mailing Address - Fax:
Practice Address - Street 1:1 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3547
Practice Address - Country:US
Practice Address - Phone:954-320-2889
Practice Address - Fax:954-785-8998
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME116414207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14R3POtherFLORIDA BLUE
FL009143000Medicaid
FLHL323ZMedicare PIN