Provider Demographics
NPI:1053310342
Name:ABUSUWA, JAMAL A (MD)
Entity type:Individual
Prefix:DR
First Name:JAMAL
Middle Name:A
Last Name:ABUSUWA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ALAFAYA WOODS BLVD STE 1000
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6212
Mailing Address - Country:US
Mailing Address - Phone:321-765-7065
Mailing Address - Fax:321-765-7061
Practice Address - Street 1:220 ALAFAYA WOODS BLVD STE 1000
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6212
Practice Address - Country:US
Practice Address - Phone:321-765-7065
Practice Address - Fax:321-765-7061
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87949207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268174900Medicaid
FL0033BOtherGENERAL PRACTICE
FL43010OtherBCBS
FLGF041AMedicare PIN
FLI14889Medicare UPIN