Provider Demographics
NPI:1467023515
Name:IRFAN, MOHAMMAD SAMEER
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:SAMEER
Last Name:IRFAN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:SAMEER
Other - Middle Name:
Other - Last Name:IRFAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:910 S DONAHUE DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-2975
Mailing Address - Country:US
Mailing Address - Phone:334-442-4000
Mailing Address - Fax:
Practice Address - Street 1:350 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3838
Practice Address - Country:US
Practice Address - Phone:478-765-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QS1000X
TXV2761207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health