Provider Demographics
NPI:1548294630
Name:SIDDIQI, ANWER MUKHTAR (MD)
Entity type:Individual
Prefix:
First Name:ANWER
Middle Name:MUKHTAR
Last Name:SIDDIQI
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:PO BOX 44008
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-4218
Mailing Address - Fax:904-244-4060
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-4218
Practice Address - Fax:904-244-4060
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17808207ZP0102X
FLME113588207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003127931AMedicaid
FL14N4JOtherBCBS FL
MSP00622805OtherRR MEDICARE
FL007244100Medicaid
MSP00236922OtherRR MEDICARE
MS00126474Medicaid
MS1885797Medicaid
MSP00622805OtherRR MEDICARE
GA003127931AMedicaid
MS302I228881Medicare PIN
FL007244100Medicaid
MS00126474Medicaid