Healthcare Provider Details

I. General information

NPI: 1174175376
Provider Name (Legal Business Name): MUSTAFEEZ UR RAHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD STE A107
MOBILE AL
36608-6774
US

IV. Provider business mailing address

6701 AIRPORT BLVD STE A107
MOBILE AL
36608-6774
US

V. Phone/Fax

Practice location:
  • Phone: 251-433-4700
  • Fax: 251-435-8549
Mailing address:
  • Phone: 251-433-4700
  • Fax: 251-435-8549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD.45795
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: