Provider Demographics
NPI:1801961420
Name:MOBIN, ANJUM (MD)
Entity type:Individual
Prefix:
First Name:ANJUM
Middle Name:
Last Name:MOBIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANJUM
Other - Middle Name:
Other - Last Name:IQBAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6601 CENTRAL FLORIDA PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-8064
Mailing Address - Country:US
Mailing Address - Phone:407-264-7551
Mailing Address - Fax:407-264-7748
Practice Address - Street 1:6601 CENTRAL FLORIDA PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-8064
Practice Address - Country:US
Practice Address - Phone:407-264-7551
Practice Address - Fax:407-264-7748
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD608815702084P0800X
MO20190101722084P0800X
ORMD1872542084P0800X
WI197-3202084P0800X
MN642652084P0800X
TXR89452084P0800X
FLME922412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272528200Medicaid
FL01619ZMedicare PIN
I32604Medicare UPIN