Provider Demographics
NPI:1578528428
Name:ANSARI, MOHAMMAD T (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:T
Last Name:ANSARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:308 W HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4716
Mailing Address - Country:US
Mailing Address - Phone:352-726-8353
Mailing Address - Fax:352-726-0090
Practice Address - Street 1:5606 W NORVELL BRYANT HWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-7572
Practice Address - Country:US
Practice Address - Phone:352-795-9266
Practice Address - Fax:352-795-9205
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059848207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12967OtherBLUE CROSS/BLUE SHIELD
FL060018560OtherRAIL ROAD MEDICARE
FLF02587Medicare UPIN
FL12967OtherBLUE CROSS/BLUE SHIELD