Provider Demographics
NPI:1992200984
Name:ALI, DAVID S
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:ALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 W LAKE MARY BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3344
Mailing Address - Country:US
Mailing Address - Phone:407-332-7700
Mailing Address - Fax:407-332-9749
Practice Address - Street 1:4106 W LAKE MARY BLVD STE 215
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3344
Practice Address - Country:US
Practice Address - Phone:407-332-7700
Practice Address - Fax:407-332-9749
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD96925208800000X
FLME175272208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology