Provider Demographics
NPI:1710900337
Name:RAZAQ, MOHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:RAZAQ
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 1:800 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5418
Mailing Address - Country:US
Mailing Address - Phone:405-271-4022
Mailing Address - Fax:405-271-4221
Practice Address - Street 1:800 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5418
Practice Address - Country:US
Practice Address - Phone:405-271-4022
Practice Address - Fax:405-271-4221
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239748-1207P00000X
NY239748207RH0003X
IA37718207RH0003X
KS04-34793207RX0202X, 207R00000X
OK28999207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02644219Medicaid
IA1710900337Medicaid
KS200716710AMedicaid
KS200716710AMedicaid
NY288AY06541Medicare PIN
IA1710900337Medicaid
IA1710900337Medicare PIN