Provider Demographics
NPI:1487851812
Name:ANWAR, TEMOOR SAJJAD (MD)
Entity Type:Individual
Prefix:
First Name:TEMOOR
Middle Name:SAJJAD
Last Name:ANWAR
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 1:3081 RIO BAYA N
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3721
Mailing Address - Country:US
Mailing Address - Phone:831-392-6393
Mailing Address - Fax:530-842-9054
Practice Address - Street 1:765 W NASA BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1815
Practice Address - Country:US
Practice Address - Phone:321-733-5725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1346962085R0202X, 2085R0204X
CAA1036412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BH619YMedicare PIN
BH619ZMedicare PIN
BH619VMedicare PIN
BH619WMedicare PIN
BH619XMedicare PIN
BH619UMedicare PIN