Provider Demographics
NPI:1568594893
Name:ANWAR, MOHAMMAD AFTAB (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:AFTAB
Last Name:ANWAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:M. AFTAB
Other - Middle Name:
Other - Last Name:ANWAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3704 BIENVILLE BLVD
Mailing Address - Street 2:SUITE A3
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5710
Mailing Address - Country:US
Mailing Address - Phone:228-872-2703
Mailing Address - Fax:228-872-8181
Practice Address - Street 1:3704 BIENVILLE BLVD
Practice Address - Street 2:SUITE A3
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5710
Practice Address - Country:US
Practice Address - Phone:228-872-2703
Practice Address - Fax:228-872-8181
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12803207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00016324Medicaid
MS00016324Medicaid