Provider Demographics
NPI:1811928674
Name:ASIF, MOHAMMED ABDUL BARI (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:ABDUL BARI
Last Name:ASIF
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 1:151 VICTORIA COMMONS BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7722
Mailing Address - Country:US
Mailing Address - Phone:386-740-4083
Mailing Address - Fax:
Practice Address - Street 1:151 VICTORIA COMMONS BLVD STE 104
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-7722
Practice Address - Country:US
Practice Address - Phone:386-740-4083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME#94467207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
U6892XOtherMEDICARE PTAN
FLI49305Medicare UPIN