Healthcare Provider Details

I. General information

NPI: 1669411161
Provider Name (Legal Business Name): MOHAMMAD AFZAL MD MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 CITRUS TOWER BLVD STE 102
CLERMONT FL
34711-1908
US

IV. Provider business mailing address

265 CITRUS TOWER BLVD STE 102
CLERMONT FL
34711-1908
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-3929
  • Fax: 352-394-6446
Mailing address:
  • Phone: 352-394-3929
  • Fax: 352-394-6446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 72542
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3193271205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: