Healthcare Provider Details

I. General information

NPI: 1730939547
Provider Name (Legal Business Name): SYED MUJTABA AZHAR BOKHARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SYED MUJTABA AZHAR BOKHARI MD

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 09/28/2024
Certification Date: 09/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 UNIVERSITY HOSPITAL DR RM 714
MOBILE AL
36617-2300
US

IV. Provider business mailing address

2451 UNIVERSITY HOSPITAL DR RM 714
MOBILE AL
36617-2300
US

V. Phone/Fax

Practice location:
  • Phone: 251-434-3915
  • Fax: 251-415-1387
Mailing address:
  • Phone: 251-434-3915
  • Fax: 251-415-1387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL.6200R
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: