Provider Demographics
NPI:1992037121
Name:CHOUDHARY, MOHAMMAD SALMAN (MD PHD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:SALMAN
Last Name:CHOUDHARY
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1302 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-5042
Mailing Address - Country:US
Mailing Address - Phone:386-328-0108
Mailing Address - Fax:386-325-1086
Practice Address - Street 1:1455 DUNN AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1437
Practice Address - Country:US
Practice Address - Phone:386-323-9600
Practice Address - Fax:386-323-9695
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN343208D00000X
PR17816208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice