Provider Demographics
NPI:1497929319
Name:RIAZ, WASIF (MD)
Entity Type:Individual
Prefix:DR
First Name:WASIF
Middle Name:
Last Name:RIAZ
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:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:4420 SUN N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2164
Practice Address - Country:US
Practice Address - Phone:863-385-1244
Practice Address - Fax:863-385-6086
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119193207RX0202X
NYRESIDENT (NONE)207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology