Provider Demographics
NPI:1275539447
Name:GAJRAJ, MOHAMED HASHIM (MD)
Entity Type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:HASHIM
Last Name:GAJRAJ
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 1:10000 W SAMPLE ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065
Mailing Address - Country:US
Mailing Address - Phone:754-812-1000
Mailing Address - Fax:954-775-0661
Practice Address - Street 1:10000 W SAMPLE ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065
Practice Address - Country:US
Practice Address - Phone:754-812-1000
Practice Address - Fax:954-775-0661
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53507207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063237600Medicaid
FL063237602Medicaid
FLA73262Medicare UPIN
FL09566ZMedicare PIN
FL063237602Medicaid
FL09566Medicare PIN