Basic Information
| Provider Information | |||||||||
| NPI: | 1861444879 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABDULLAH | ||||||||
| FirstName: | SHUKRI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 653 W 23RD STREET | ||||||||
| Address2: | PMB 244 | ||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324053992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502152337 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1200 RIVERPLACE BLVD | ||||||||
| Address2: | SUITE: 620 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322079046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043966620 | ||||||||
| FaxNumber: | 9043966528 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 01/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME108424 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | A96702 | CA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 2018042049 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | A96702 | 01 | CA | MEDICAL LICENSE | OTHER | 0-608-847-0 | 01 | CA | ECFMG | OTHER | 00A967020 | 05 | CA | MEDICAID |