Provider Demographics
NPI:1669576104
Name:RIAZ, MOHAMMAD (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:RIAZ
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 1268
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34973-1268
Mailing Address - Country:US
Mailing Address - Phone:863-763-4011
Mailing Address - Fax:863-467-1156
Practice Address - Street 1:204 N E 19TH DRIVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1932
Practice Address - Country:US
Practice Address - Phone:863-763-4011
Practice Address - Fax:863-467-1156
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL43238207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2014769OtherCLIA CERTIFICATE OF WAIVER
FL060054371OtherRAILROAD MEDICARE
FL068559300Medicaid
FL592401624OtherTRICARE
FL592401624OtherTRICARE
FL068559300Medicaid