Provider Demographics
NPI:1144667999
Name:ABBAS, ALI (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:ABBAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3001 EXECUTIVE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-5323
Mailing Address - Country:US
Mailing Address - Phone:727-347-0005
Mailing Address - Fax:727-541-6558
Practice Address - Street 1:3821 MARYWEATHER LN STE 101
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7793
Practice Address - Country:US
Practice Address - Phone:813-367-1585
Practice Address - Fax:813-367-1586
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME130047207RG0100X
FLTRN19081207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106558500Medicaid
FLKCE42OtherBLUE CROSS BLUE SHIELD