Provider Demographics
NPI:1962719187
Name:DR SYED W. ALI
Entity type:Organization
Organization Name:DR SYED W. ALI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:WASIM
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-824-5386
Mailing Address - Street 1:2465 US HIGHWAY 1 S STE NO19
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6076
Mailing Address - Country:US
Mailing Address - Phone:904-824-7476
Mailing Address - Fax:904-824-7078
Practice Address - Street 1:1680 OSCEOLA ELEMENTARY RD STE A
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-5942
Practice Address - Country:US
Practice Address - Phone:904-824-7476
Practice Address - Fax:904-824-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty