Individual provider Active NPI

Amir Mohammadi, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Jacksonville, FL
National Provider Identifier
1023179470
Registry record updated Jul 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
TRN8405 Issued in FL
Practice address
11156 Wyndham Hollow LN
Jacksonville, FL 32246-8480
Phone
(480) 215-2101
Fax
(904) 244-4060
NPI assigned
Dec 12, 2006
Last updated
Jul 6, 2009By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 6, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X TRN8405 FL Primary

Addresses

Primary practice location

11156 Wyndham Hollow LN
Jacksonville, FL 32246-8480

Mailing address

11156 Wyndham Hollow LN
Jacksonville, FL 32246-8480
Phone (480) 215-2101

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
TRN8405FLMDAnatomic Pathology & Clinical Pathology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246838400000",
    "number": "1023179470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11156 WYNDHAM HOLLOW LN",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322468480",
            "telephone_number": "480-215-2101",
            "fax_number": "904-244-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11156 WYNDHAM HOLLOW LN",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322468480",
            "telephone_number": "480-215-2101",
            "fax_number": "904-244-4060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHAMMADI",
        "first_name": "AMIR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2009-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "FL",
            "license": "TRN8405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.