Provider Demographics
NPI:1629182597
Name:RAHMAN, MOHAMMED FAZLUR (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:FAZLUR
Last Name:RAHMAN
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 1:7916 HARMONY LAKE CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-6802
Mailing Address - Country:US
Mailing Address - Phone:239-274-6652
Mailing Address - Fax:
Practice Address - Street 1:3033 WINKLER AVENUE EXT
Practice Address - Street 2:VA OUTPATIENT CLINIC
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9413
Practice Address - Country:US
Practice Address - Phone:239-939-3939
Practice Address - Fax:239-931-6116
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL70930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine