Provider Demographics
NPI:1467959908
Name:RIAZ, AHMED (DO)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:RIAZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3342 NE 34TH ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-6906
Mailing Address - Country:US
Mailing Address - Phone:954-358-2363
Mailing Address - Fax:954-306-2232
Practice Address - Street 1:3342 NE 34TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-6906
Practice Address - Country:US
Practice Address - Phone:954-358-2363
Practice Address - Fax:954-306-2232
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS17807207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine