Provider Demographics
NPI:1407934912
Name:LATIF JANGDA, MOHAMMAD JAWED (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:JAWED
Last Name:LATIF JANGDA
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 1:8050 N UNIVERSITY DR
Mailing Address - Street 2:STE 201
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2102
Mailing Address - Country:US
Mailing Address - Phone:854-532-2920
Mailing Address - Fax:866-843-0820
Practice Address - Street 1:2225 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3611
Practice Address - Country:US
Practice Address - Phone:954-730-3340
Practice Address - Fax:954-730-8879
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME788982084A0401X, 2084P0015X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001448700Medicaid
FL001448700Medicaid
FL35273YMedicare PIN
FLBE387Medicare PIN