Provider Demographics
NPI:1780675405
Name:AZIZ, NABIL (MD)
Entity type:Individual
Prefix:DR
First Name:NABIL
Middle Name:
Last Name:AZIZ
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 1:1257 FLORIDA AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2488
Mailing Address - Country:US
Mailing Address - Phone:321-631-1007
Mailing Address - Fax:321-636-1819
Practice Address - Street 1:1257 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2488
Practice Address - Country:US
Practice Address - Phone:321-631-1007
Practice Address - Fax:321-636-1819
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 67818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378677300Medicaid
FL26795BMedicare ID - Type Unspecified
FLG03494Medicare UPIN