| Entity Name: | DR EJAZ AHMED MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 19 Aug 2010 (14 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 10 Nov 2016 (8 years ago) |
| Document Number: | P10000068311 |
| FEI/EIN Number | 273282100 |
| Address: | 405 N. CLYDE MORRIS BLVD., DAYTONA BEACH, FL, 32114, US |
| Mail Address: | 810 Pheasant Run CT W, PORT ORANGE, FL, 32127, US |
| ZIP code: | 32114 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245636042 | 2014-11-06 | 2014-11-06 | 3848 CALLIOPE AVE, PORT ORANGE, FL, 321296025, US | 405 NORTH CLYDE MORRIS BLVD, DAYTONA BEACH, FL, 321142730, US | |||||||||||||||||||
|
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| Phone | +1 386-235-8731 |
| Fax | 3862699555 |
Authorized person
| Name | DR. EJAZ AHMED |
| Role | PRESIDENT |
| Phone | 3862358731 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME95557 |
| State | FL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| PINNACLE SIGNATURE GROUP INC. | Agent |
| Name | Role | Address |
|---|---|---|
| AHMED EJAZ | Director | 810 Pheasant Run CT W, PORT ORANGE, FL, 32127 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000039775 | DR EJAZ AHMED MD PA D/B URGENT CARE & FAMILY PRACTICE CENTER | ACTIVE | 2020-04-09 | 2025-12-31 | No data | 405 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL, 32114 |
| G14000108873 | DR EJAZ AHMED MD PA D/B URGENT CARE & FAMILY PRACTICE CENTER | EXPIRED | 2014-10-28 | 2019-12-31 | No data | 3848 CALLIOPE AVENUE, PORT ORANGE, FL, 32129 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-03-10 | 405 N. CLYDE MORRIS BLVD., DAYTONA BEACH, FL 32114 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-04-14 | 927 BEVILLE ROAD, SUITE 109, SOUTH DAYTONA, FL 32119 | No data |
| REGISTERED AGENT NAME CHANGED | 2018-04-27 | PINNACLE SIGNATURE GROUP INC. | No data |
| REINSTATEMENT | 2016-11-10 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-11-10 | 405 N. CLYDE MORRIS BLVD., DAYTONA BEACH, FL 32114 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-14 |
| ANNUAL REPORT | 2023-02-13 |
| ANNUAL REPORT | 2022-03-10 |
| ANNUAL REPORT | 2021-04-19 |
| ANNUAL REPORT | 2020-04-14 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-04-27 |
| ANNUAL REPORT | 2017-05-01 |
| REINSTATEMENT | 2016-11-10 |
| ANNUAL REPORT | 2015-04-28 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
