Provider Demographics
NPI:1063526614
Name:MOHIUDDIN, ABID (MD)
Entity type:Individual
Prefix:DR
First Name:ABID
Middle Name:
Last Name:MOHIUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 S HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7836
Mailing Address - Country:US
Mailing Address - Phone:870-939-6380
Mailing Address - Fax:870-535-2801
Practice Address - Street 1:788 SCOGIN DRIVE
Practice Address - Street 2:DREW MEMORIAL HEALTH SYSTEM
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655
Practice Address - Country:US
Practice Address - Phone:870-500-0595
Practice Address - Fax:870-535-2801
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020025230207RH0003X
ARE-4335207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G58363Medicare UPIN