Healthcare Provider Details

I. General information

NPI: 1497929319
Provider Name (Legal Business Name): WASIF RIAZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40215 HIGHWAY 27
DAVENPORT FL
33837-7813
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 863-421-9705
  • Fax: 863-421-9779
Mailing address:
  • Phone: 239-274-8200
  • Fax: 239-278-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME119193
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: