Provider Demographics
NPI:1831145929
Name:AHMAD, MAHMOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHMOOD
Middle Name:
Last Name:AHMAD
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 1:17901 CHENAL PKWY
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-5831
Mailing Address - Country:US
Mailing Address - Phone:501-834-7246
Mailing Address - Fax:501-542-4295
Practice Address - Street 1:4050 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5223
Practice Address - Country:US
Practice Address - Phone:907-312-1637
Practice Address - Fax:501-542-4295
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1687207LP2900X, 207LP2900X
IN01058379A207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148359001Medicaid
AR5M117Medicare ID - Type Unspecified
ARH57467Medicare UPIN
AKK166303Medicare PIN