Provider Demographics
NPI:1275539447
Name:GAJRAJ, MOHAMED HASHIM (MD)
Entity type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:HASHIM
Last Name:GAJRAJ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W COLONIAL DR STE 303
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6863
Mailing Address - Country:US
Mailing Address - Phone:833-702-8383
Mailing Address - Fax:689-304-0303
Practice Address - Street 1:1037 S STATE ROAD 7 STE 211
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6139
Practice Address - Country:US
Practice Address - Phone:561-798-3030
Practice Address - Fax:561-798-8242
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53507207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063237600Medicaid
FL063237602Medicaid
FLA73262Medicare UPIN
FL09566ZMedicare PIN
FL063237602Medicaid
FL09566Medicare PIN