Provider Demographics
NPI:1730190042
Name:ASHDJI, REZWAN R (MD)
Entity type:Individual
Prefix:MRS
First Name:REZWAN
Middle Name:R
Last Name:ASHDJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6573 A1A SOUTH
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080
Mailing Address - Country:US
Mailing Address - Phone:904-342-7363
Mailing Address - Fax:904-342-7367
Practice Address - Street 1:1301 PLANTATION ISLAND DR S
Practice Address - Street 2:SUITE 402 B
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3108
Practice Address - Country:US
Practice Address - Phone:904-823-3777
Practice Address - Fax:904-823-3363
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF75286Medicare UPIN
FL23789ZMedicare PIN
FL23789ZMedicare PIN