Provider Demographics
NPI:1760958946
Name:MOHAMMAD T JAVED, MDPA
Entity Type:Organization
Organization Name:MOHAMMAD T JAVED, MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:T
Authorized Official - Last Name:JAVED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-204-5111
Mailing Address - Street 1:11476 OKEECHOBEE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8715
Mailing Address - Country:US
Mailing Address - Phone:561-204-5111
Mailing Address - Fax:561-204-5150
Practice Address - Street 1:6169 S JOG RD STE B4
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-6514
Practice Address - Country:US
Practice Address - Phone:561-249-6959
Practice Address - Fax:561-268-2133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOHAMMAD T JAVED, MDPA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269144200Medicaid