Healthcare Provider Details

I. General information

NPI: 1114919503
Provider Name (Legal Business Name): MOHAMMAD JAHANZEB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 W MAYA PALM DR
BOCA RATON FL
33432-7972
US

IV. Provider business mailing address

2155 W MAYA PALM DR
BOCA RATON FL
33432-7972
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-0486
  • Fax:
Mailing address:
  • Phone: 910-483-0486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number36771
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number17856
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberE3595
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME68929
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: