Basic Information
Provider Information
NPI: 1336408020
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BASHIR
FirstName: SAEED
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 655 W 8TH ST
Address2:  
City: JACKSONVILLE
State: FL
PostalCode: 322096511
CountryCode: US
TelephoneNumber: 9042443660
FaxNumber:  
Practice Location
Address1: 655 W 8TH ST
Address2:  
City: JACKSONVILLE
State: FL
PostalCode: 322096511
CountryCode: US
TelephoneNumber: 9043831024
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/15/2012
LastUpdateDate: 10/05/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0204XME138098FLY Allopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology

No ID Information.


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