Provider Demographics
NPI:1104221910
Name:MOHAMMAD T JAVED, MD PA
Entity Type:Organization
Organization Name:MOHAMMAD T JAVED, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:T
Authorized Official - Last Name:JAVED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-339-5909
Mailing Address - Street 1:25 SE MLK BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-4044
Mailing Address - Country:US
Mailing Address - Phone:561-983-8571
Mailing Address - Fax:561-204-5150
Practice Address - Street 1:25 SE MLK BLVD
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-4044
Practice Address - Country:US
Practice Address - Phone:561-983-8571
Practice Address - Fax:561-204-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071079261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIC956AMedicare Oscar/Certification