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General NPI Number Information
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NPI Number | 1043520299
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Entity Type | Organization
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Legal Business Name | MOHAMMAD RIAZ MD
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 204 NE 19TH DR
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City | OKEECHOBEE
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State | FL
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Zip | 34972-1932
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Country | US
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Telephone | 863-763-4011
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Fax | 863-467-1156
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Provider Business Mailing Address
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Address Line | 204 NE 19TH DR
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City | OKEECHOBEE
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State | FL
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Zip | 34972-1932
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Country | US
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Telephone | 863-763-4011
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Fax | 863-467-1156
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | LAURA ANN JOHNSON
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Credential |
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Telephone | 863-763-4011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME43238
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License Number State | FL
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