Provider Demographics
NPI:1821075672
Name:WAZIRI, MOHAMMAD ASIF (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:ASIF
Last Name:WAZIRI
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 1:147 GEMINI DR
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-2389
Mailing Address - Country:US
Mailing Address - Phone:573-248-8639
Mailing Address - Fax:
Practice Address - Street 1:2305 GERORGIA ST
Practice Address - Street 2:
Practice Address - City:LOUISIANA
Practice Address - State:MO
Practice Address - Zip Code:63353
Practice Address - Country:US
Practice Address - Phone:573-754-5531
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001010816207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2001010816OtherMISSOURI STATE LICENSE
MO2001010816OtherMISSOURI STATE LICENSE