Provider Demographics
NPI:1265453120
Name:MOIZUDDIN, SAMIA SANA (MD)
Entity Type:Individual
Prefix:
First Name:SAMIA
Middle Name:SANA
Last Name:MOIZUDDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 HIGHWAY 78 E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3959
Mailing Address - Country:US
Mailing Address - Phone:205-387-9787
Mailing Address - Fax:205-387-9952
Practice Address - Street 1:1090 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3959
Practice Address - Country:US
Practice Address - Phone:205-387-9787
Practice Address - Fax:205-387-9952
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24363207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529900540Medicaid
AL051504982OtherBC/BS
AL051504982OtherBC/BS
051504982Medicare ID - Type Unspecified