Provider Demographics
NPI:1033686704
Name:ABDELMOATY, WALAA F R (MBCHB)
Entity Type:Individual
Prefix:DR
First Name:WALAA
Middle Name:F R
Last Name:ABDELMOATY
Suffix:
Gender:M
Credentials:MBCHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E 200 S RM 1202
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2472
Mailing Address - Country:US
Mailing Address - Phone:801-581-3841
Mailing Address - Fax:
Practice Address - Street 1:250 E 200 S RM 1202
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2472
Practice Address - Country:US
Practice Address - Phone:801-581-3841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61191640208D00000X
UT12701017-12052083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice