Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Rezwan Islam, MD

Individual provider Family Medicine Physician · NPI 1124054556

Dr. Rezwan Islam, MD is a Family Practice in Fulton, Missouri. Qualified in 2004, 22 years ago. Practices with Jefferson City Medical Group PC, a 117-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Missouri.

Years since qualifying
22
Licensed in
MO
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

850 N Hospital Dr Ste D
Fulton, MO 65251-2535
Phone: (573) 642-5338
Fax: (573) 642-9224
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 2004010833 (MO)

Record details

NPI number1124054556
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 25, 2006
Last updated in NPPESAugust 9, 2013
Mailing address850 N Hospital Dr, Ste F, Fulton, MO 65251-2535

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Jefferson City Medical Group Pc — 117 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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