Provider Demographics
NPI:1215932538
Name:MIRZA, MOHAMMAD RAASHID (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:RAASHID
Last Name:MIRZA
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:PO BOX 69004
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71306-9004
Mailing Address - Country:US
Mailing Address - Phone:318-466-4299
Mailing Address - Fax:419-251-6827
Practice Address - Street 1:2495 SHREVEPORT HWY 71
Practice Address - Street 2:
Practice Address - City:PINEVILE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:419-251-3711
Practice Address - Fax:419-251-6827
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.059249207RC0000X
OH35059249207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2417110Medicaid
OH4105832Medicare PIN
OH2417110Medicaid
OHC30243Medicare UPIN