Individual provider Active NPI

Mohammed Fazlur Rahman, M.D.

  • Internal Medicine Physician
  • Fort Myers, FL
National Provider Identifier
1629182597
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
70930 Issued in FL
Practice address
3033 Winkler Avenue Ext
VA Outpatient Clinic
Fort Myers, FL 33916-9413
Phone
(239) 939-3939
Fax
(239) 931-6116
NPI assigned
Aug 18, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 70930 FL Primary

Addresses

Primary practice location

3033 Winkler Avenue Ext
VA Outpatient Clinic
Fort Myers, FL 33916-9413

Mailing address

7916 Harmony Lake CT
Fort Myers, FL 33907-6802
Phone (239) 274-6652

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130802000069 FL Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 2668613688

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
70930FLMDInternal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629182597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7916 HARMONY LAKE CT",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339076802",
            "telephone_number": "239-274-6652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3033 WINKLER AVENUE EXT",
            "address_2": "VA OUTPATIENT CLINIC",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339169413",
            "telephone_number": "239-939-3939",
            "fax_number": "239-931-6116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAHMAN",
        "first_name": "MOHAMMED",
        "middle_name": "FAZLUR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "70930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.