Provider Demographics
NPI:1437265972
Name:MOHIUDDIN, JAVED (MD)
Entity type:Individual
Prefix:DR
First Name:JAVED
Middle Name:
Last Name:MOHIUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAVED
Other - Middle Name:
Other - Last Name:MOHIUDDIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3502 FARRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3450
Mailing Address - Country:US
Mailing Address - Phone:228-547-9469
Mailing Address - Fax:228-868-4986
Practice Address - Street 1:GULF COAST VETERANS HEALTH CARE SYSTEM
Practice Address - Street 2:400 VETERANS AVENUE
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2410
Practice Address - Country:US
Practice Address - Phone:228-523-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15945207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119777Medicaid
MS302I935924Medicare PIN
MS00119777Medicaid
MSF43008Medicare UPIN
MS110001958Medicare PIN