Organization
MOHAMMAD IDREES MD, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER LEE TEDDER (MEDICAL ASSISTANT)
(321) 723-2121
Entity
Organization
Contact information
Practice address
1454 BELAIRE LANE N.E., PALM BAY, FL 32905
(321) 723-2121
(321) 723-7478
Mailing address
1454 BELAIRE LANE N.E., PALM BAY, FL 32905
(321) 723-2121
(321) 723-7478
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
ME22385
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
#054484100
—
FL
Enumeration date
05/23/2012
Last updated
05/23/2012
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