Provider Demographics
NPI:1700179231
Name:MASUD, MUHAMMAD WAQAS (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:WAQAS
Last Name:MASUD
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 1:9110 COLLEGE POINTE CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3244
Mailing Address - Country:US
Mailing Address - Phone:239-560-4310
Mailing Address - Fax:904-551-3624
Practice Address - Street 1:9110 COLLEGE POINTE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3244
Practice Address - Country:US
Practice Address - Phone:239-560-4310
Practice Address - Fax:904-551-3624
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010773412084N0400X
MI43011140452084N0400X
TXTM007422084N0400X
NH185812084N0400X
ND150312084N0400X
OH35.1324012084N0400X
ORMD1857022084N0400X
MS256022084N0400X
NY2962472084N0400X
FLME1332612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3116720Medicaid