Basic Information
| Provider Information | |||||||||
| NPI: | 1720361835 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAWOUD | ||||||||
| FirstName: | MALIK | ||||||||
| MiddleName: | ALI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100374 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522650291 | ||||||||
| FaxNumber: | 3522650279 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 SW ARCHER RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326103607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522650291 | ||||||||
| FaxNumber: | 3522650279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2011 | ||||||||
| LastUpdateDate: | 01/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | ME143300 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085P0229X | C1-0013542 | DE | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085P0229X | ME143300 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0202X | E-9826 | AR | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.