Provider Demographics
NPI:1740391341
Name:NAWAZ, MAZHAR G (MD)
Entity Type:Individual
Prefix:DR
First Name:MAZHAR
Middle Name:G
Last Name:NAWAZ
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 1:11268 S APOPKA VINELAND RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-6152
Mailing Address - Country:US
Mailing Address - Phone:407-465-1996
Mailing Address - Fax:407-465-1997
Practice Address - Street 1:11268 S APOPKA VINELAND RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-6152
Practice Address - Country:US
Practice Address - Phone:407-465-1996
Practice Address - Fax:407-465-1997
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0025826208600000X, 208D00000X
FLME25826208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
209687OtherAMERIGROUP
6014405OtherGHI GROUP
591709547OtherUNITED HEALTH
D56684Medicare UPIN
FL54040XMedicare PIN