Provider Demographics
NPI:1699708222
Name:NOUNEH, NAJI (MD)
Entity type:Individual
Prefix:
First Name:NAJI
Middle Name:
Last Name:NOUNEH
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 1:9860 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-4704
Mailing Address - Country:US
Mailing Address - Phone:904-807-9112
Mailing Address - Fax:904-807-9114
Practice Address - Street 1:9860 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-4704
Practice Address - Country:US
Practice Address - Phone:904-807-9112
Practice Address - Fax:904-807-9114
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90121207R00000X
FLME107361207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME107361OtherFL DEPT OF HEALTH
CAI05495Medicare UPIN