Provider Demographics
NPI:1114168689
Name:SAJID, MANSOOR AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:MANSOOR
Middle Name:AHMED
Last Name:SAJID
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 1:19006 WILDBLUE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8752
Mailing Address - Country:US
Mailing Address - Phone:713-398-0332
Mailing Address - Fax:
Practice Address - Street 1:2848 CENTER POINTE DR STE A
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9521
Practice Address - Country:US
Practice Address - Phone:239-561-9622
Practice Address - Fax:239-768-5297
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6779059-1205207ZP0102X
TXM8309207ZP0102X
FLME119814207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106007100Medicaid