Provider Demographics
NPI:1679769293
Name:ASHRAF ELSAKR, M.D., P.A.,
Entity type:Organization
Organization Name:ASHRAF ELSAKR, M.D., P.A.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:S
Authorized Official - Last Name:ELSAKR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-304-9672
Mailing Address - Street 1:840 DUNLAWTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4223
Mailing Address - Country:US
Mailing Address - Phone:386-304-9672
Mailing Address - Fax:386-304-9673
Practice Address - Street 1:840 DUNLAWTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4223
Practice Address - Country:US
Practice Address - Phone:386-304-9672
Practice Address - Fax:386-304-9673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70981207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250345000Medicaid
FLK4610Medicare PIN
FL250345000Medicaid