Provider Demographics
NPI:1962413179
Name:SHARIAT, ABBAS (MD)
Entity type:Individual
Prefix:
First Name:ABBAS
Middle Name:
Last Name:SHARIAT
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 1:1361 13TH AVE S
Mailing Address - Street 2:STE #140
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250
Mailing Address - Country:US
Mailing Address - Phone:904-246-9464
Mailing Address - Fax:904-246-2528
Practice Address - Street 1:1361 13TH AVE S
Practice Address - Street 2:STE #140
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250
Practice Address - Country:US
Practice Address - Phone:904-246-9464
Practice Address - Fax:904-246-2528
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41360208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4197924OtherAETNA
FL45030Medicare ID - Type Unspecified
D21596Medicare UPIN