Provider Demographics
NPI:1215381140
Name:HATAHET, MOHAMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:
Last Name:HATAHET
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 1:6500 W NEWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4309
Mailing Address - Country:US
Mailing Address - Phone:352-333-5159
Mailing Address - Fax:352-333-3157
Practice Address - Street 1:810 NW 16TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4012
Practice Address - Country:US
Practice Address - Phone:352-333-5700
Practice Address - Fax:352-376-4975
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN22621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine