Provider Demographics
NPI:1114919503
Name:JAHANZEB, MOHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:JAHANZEB
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 1:2155 W MAYA PALM DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-7972
Mailing Address - Country:US
Mailing Address - Phone:910-483-0486
Mailing Address - Fax:
Practice Address - Street 1:2155 W MAYA PALM DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-7972
Practice Address - Country:US
Practice Address - Phone:910-483-0486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36771207RH0003X
MS17856207RH0003X
ARE3595207RH0003X
FLME68929207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3875593Medicaid
TN135154OtherBETTER HEALTH TNCARE
AR99443OtherBLUE CROSS BLUE SHIELD
3823561OtherCIGNA
MS01737521Medicaid
TN24178OtherTLC TNCARE
TN4047652OtherBLUE CROSS BLUE SHIELD
FL101167900Medicaid
4221351OtherAETNA
AR148871001Medicaid