Provider Demographics
NPI:1447416003
Name:MOHIUDDIN, FAWWAZ JAFFER (MD)
Entity Type:Individual
Prefix:
First Name:FAWWAZ
Middle Name:JAFFER
Last Name:MOHIUDDIN
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 1:3001 NW 49TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-7266
Mailing Address - Country:US
Mailing Address - Phone:954-739-2273
Mailing Address - Fax:954-497-1897
Practice Address - Street 1:3001 NW 49TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7266
Practice Address - Country:US
Practice Address - Phone:954-739-2273
Practice Address - Fax:954-497-1897
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108788207XX0005X
IL125-049640207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery