Provider Demographics
NPI:1457520769
Name:SAFDER, MANZOOR HUSSAIN (MD)
Entity type:Individual
Prefix:DR
First Name:MANZOOR
Middle Name:HUSSAIN
Last Name:SAFDER
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 1:9400 TURKEY LAKE RD
Mailing Address - Street 2:MP 452
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8001
Mailing Address - Country:US
Mailing Address - Phone:321-843-5500
Mailing Address - Fax:321-843-5550
Practice Address - Street 1:9400 TURKEY LAKE RD
Practice Address - Street 2:MP 452
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8001
Practice Address - Country:US
Practice Address - Phone:321-843-5500
Practice Address - Fax:321-843-5550
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105486207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002913100Medicaid
FLME105486OtherMEDICAL LICENSE
FLCO951XMedicare PIN