Provider Demographics
NPI:1497158836
Name:AL-RASHID, MAMUN (MD)
Entity Type:Individual
Prefix:
First Name:MAMUN
Middle Name:
Last Name:AL-RASHID
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 1:4560 LANTANA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6998
Mailing Address - Country:US
Mailing Address - Phone:561-967-4400
Mailing Address - Fax:844-959-0419
Practice Address - Street 1:4560 LANTANA RD STE 100
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6998
Practice Address - Country:US
Practice Address - Phone:561-967-4400
Practice Address - Fax:844-959-0419
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME141237207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108068000Medicaid