Basic Information
| Provider Information | |||||||||
| NPI: | 1942239405 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AHMAD | ||||||||
| FirstName: | AZIZ | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 30120 | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325031120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504781312 | ||||||||
| FaxNumber: | 8504749060 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 OHIO AVE | ||||||||
| Address2: | |||||||||
| City: | LYNN HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324442558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502656604 | ||||||||
| FaxNumber: | 8502654879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 03/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | ME0035715 | FL | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208600000X | ME0037515 | FL | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 40860 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 039367300 | 05 | FL | MEDICAID |