Healthcare Provider Details

I. General information

NPI: 1457353310
Provider Name (Legal Business Name): MUHAMMAD AMIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 EAST BYRD AVE
BONIFAY FL
32425
US

IV. Provider business mailing address

PO BOX 367
BONIFAY FL
32425
US

V. Phone/Fax

Practice location:
  • Phone: 850-547-3679
  • Fax: 850-547-3524
Mailing address:
  • Phone: 850-547-3679
  • Fax: 850-547-3524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME33481
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME#0033481
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME#0033481
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: