Healthcare Provider Details

I. General information

NPI: 1629119136
Provider Name (Legal Business Name): ZEESHAN ALI MAHMOOD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 N UNIVERSITY DR STE 103
CORAL SPRINGS FL
33071-8923
US

IV. Provider business mailing address

1881 N UNIVERSITY DR STE 103
CORAL SPRINGS FL
33071-8923
US

V. Phone/Fax

Practice location:
  • Phone: 954-516-0070
  • Fax: 954-516-0029
Mailing address:
  • Phone: 954-516-0070
  • Fax: 954-516-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS9601
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS9601
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: