Provider Demographics
NPI:1033425087
Name:JAVED, FAHAD (MD,)
Entity Type:Individual
Prefix:DR
First Name:FAHAD
Middle Name:
Last Name:JAVED
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 1:4215 15TH ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2523
Mailing Address - Country:US
Mailing Address - Phone:228-863-5211
Mailing Address - Fax:228-863-4101
Practice Address - Street 1:4215 15TH ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501
Practice Address - Country:US
Practice Address - Phone:228-863-5211
Practice Address - Fax:228-863-4101
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266935207R00000X
CODR.0062918207RI0011X
LAMD.206853207RI0011X
MS26033207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE-12343OtherLICENSE