MOHAMMAD BASIL AMIN MD PA
Osteopathic Medicine at Prudential Dr, Jacksonville, FL

License number
Florida ME72588
Category
Osteopathic Medicine
Type
Internal Medicine
Owner
Name: MOHAMMAD B AMIN MD
Title: OWNER
Phone: (904) 446-6666
Address
Address 2
800 Prudential Dr, Jacksonville, FL 32207
PO Box 2261, Orange Park, FL 32067
National Provider ID: 1760719702
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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MOHAMMAD BASIL AMIN M.D. PA

Jacksonville, FL  -  Palatka, FL  -  Orange Park, FL

Status:
Inactive
Industry:
Medical Doctor's Office, Nonclassifiable Establishments
Inactive reason:
CANCEL ADM DISS/REV
Registration:
Jan 6, 2003
Inactive since:
May 4, 2006
Addresses:
4500 Baymeadows Rd APT 2, Jacksonville, FL 32217 (Physical)
Jacksonville, FL 32241 (Mailing)
PO Box 2468, Palatka, FL 32178
599 Chivas Ct, Orange Park, FL 32073
State ID:
P03000001331
Business type:
Florida Profit Corporation
Presidents:
Amin, Mohammad B , Dr, PO Box 56541, Jacksonville, FL 32241 (Physical),Mohammad B. Amin (President)
Agent:
Mohammad Amin,4500 Baymeadows Rd APT 2, Jacksonville, FL 32217 (Physical)
EIN:
33-1036799

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