Provider Demographics
NPI:1144205543
Name:MANSOUR, MONEER M (MD)
Entity Type:Individual
Prefix:
First Name:MONEER
Middle Name:M
Last Name:MANSOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8787 BRYAN DAIRY RD
Mailing Address - Street 2:STE 330
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1260
Mailing Address - Country:US
Mailing Address - Phone:727-391-8009
Mailing Address - Fax:727-391-5182
Practice Address - Street 1:8787 BRYAN DAIRY RD
Practice Address - Street 2:STE 330
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1260
Practice Address - Country:US
Practice Address - Phone:727-391-8009
Practice Address - Fax:727-391-5182
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0056911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11439Medicare ID - Type Unspecified
E67223Medicare UPIN