Provider Demographics
NPI:1114178779
Name:IZHAR, MOHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:IZHAR
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 1:2000 HARTMAN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4413
Mailing Address - Country:US
Mailing Address - Phone:724-651-1707
Mailing Address - Fax:772-465-1171
Practice Address - Street 1:2000 HARTMAN RD STE 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4413
Practice Address - Country:US
Practice Address - Phone:724-651-1707
Practice Address - Fax:772-465-1171
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122816207RN0300X
FLTRN12977390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFI9428144OtherDEA