Healthcare Provider Details

I. General information

NPI: 1801582465
Provider Name (Legal Business Name): MOHAMED IRRFAN INZAMAM SHAKUR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 OWEN DR
FAYETTEVILLE NC
28304-3425
US

IV. Provider business mailing address

PO BOX 40908
FAYETTEVILLE NC
28309-0908
US

V. Phone/Fax

Practice location:
  • Phone: 910-678-0100
  • Fax:
Mailing address:
  • Phone: 910-615-6949
  • Fax: 910-615-9761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026-02991
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: