Healthcare Provider Details

I. General information

NPI: 1003030537
Provider Name (Legal Business Name): MOHAMMAD T JAVED MD.PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11476 OKEECHOBEE BLVD
ROYAL PALM BEACH FL
33411-8715
US

IV. Provider business mailing address

11476 OKEECHOBEE BLVD
ROYAL PALM BEACH FL
33411-8715
US

V. Phone/Fax

Practice location:
  • Phone: 561-204-5111
  • Fax: 561-204-5150
Mailing address:
  • Phone: 561-204-5111
  • Fax: 561-204-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberARNP1753442
License Number StateFL

VIII. Authorized Official

Name: MISS JANET W RADFORD
Title or Position: NURSE PRACTITIONER
Credential: ARNP
Phone: 561-204-5111