Provider Demographics
NPI:1508817370
Name:MANSOOR, RIZWAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RIZWAN
Middle Name:
Last Name:MANSOOR
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 1:4500 W NEWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2245
Mailing Address - Country:US
Mailing Address - Phone:352-336-6000
Mailing Address - Fax:352-332-0799
Practice Address - Street 1:146 SW ORTHOPEDIC CT
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024-0672
Practice Address - Country:US
Practice Address - Phone:386-755-9215
Practice Address - Fax:386-755-6469
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070903207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
239211OtherAVMED
FL250668800Medicaid
239211OtherAVMED
FL250668800Medicaid
FL32116UMedicare PIN