Provider Demographics
NPI:1679654917
Name:UDDIN, MOHAMMAD J (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:J
Last Name:UDDIN
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 1:1903 HAND AVE
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-4112
Mailing Address - Country:US
Mailing Address - Phone:251-937-7970
Mailing Address - Fax:251-937-9260
Practice Address - Street 1:1903 HAND AVE
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-4112
Practice Address - Country:US
Practice Address - Phone:251-937-7970
Practice Address - Fax:251-937-9260
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.19994207P00000X
AL19994207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009936106Medicaid
AL1679654917OtherTRICARE SOUTH
AL51501310OtherBCBS AL
AL009936104Medicaid
AL009936107Medicaid
AL510-03504OtherBCBS
AL515-33349OtherBCBS
AL009950520Medicaid
AL515-32972OtherBCBS
AL515-33348OtherBCBS
AL009935491Medicaid
AL51501310OtherBCBS AL
AL515-33349OtherBCBS
AL009950520Medicaid
ALP00381392Medicare PIN