Provider Demographics
NPI:1023179470
Name:MOHAMMADI, AMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:
Last Name:MOHAMMADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11156 WYNDHAM HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8480
Mailing Address - Country:US
Mailing Address - Phone:480-215-2101
Mailing Address - Fax:904-244-4060
Practice Address - Street 1:11156 WYNDHAM HOLLOW LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-8480
Practice Address - Country:US
Practice Address - Phone:480-215-2101
Practice Address - Fax:904-244-4060
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN8405207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology