Provider Demographics
NPI:1548433949
Name:AL ASHHAB, AIHAM (MD)
Entity type:Individual
Prefix:
First Name:AIHAM
Middle Name:
Last Name:AL ASHHAB
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 1:5410 MARYLAND WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5064
Mailing Address - Country:US
Mailing Address - Phone:615-377-5667
Mailing Address - Fax:888-241-1404
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:904-244-3850
Practice Address - Fax:904-244-4799
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101201208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2813581-00Medicaid
GA505090623AMedicaid
FL29710OtherBLUE CROSS/BLUE SHIELD OF FLORIDA
FLP00710229Medicare PIN
FLBH477ZMedicare PIN
GA505090623AMedicaid