Provider Demographics
NPI:1962451971
Name:IQBAL, IJAZ MOHAMMED (MD)
Entity Type:Individual
Prefix:DR
First Name:IJAZ
Middle Name:MOHAMMED
Last Name:IQBAL
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:PO BOX 18982
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4084
Mailing Address - Country:US
Mailing Address - Phone:251-342-3949
Mailing Address - Fax:251-266-3361
Practice Address - Street 1:6801 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3709
Practice Address - Country:US
Practice Address - Phone:251-639-5775
Practice Address - Fax:251-639-2664
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-02362OtherBLUE CROSS BLUE SHIELD
AL102I112284Medicare PIN
ALG85316Medicare UPIN