Provider Demographics
NPI:1225197916
Name:MOHAMED H ANTAR MD PA
Entity Type:Organization
Organization Name:MOHAMED H ANTAR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:H
Authorized Official - Last Name:ANTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-384-8733
Mailing Address - Street 1:2150 PARK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3812
Mailing Address - Country:US
Mailing Address - Phone:904-384-8733
Mailing Address - Fax:904-384-9004
Practice Address - Street 1:2150 PARK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3812
Practice Address - Country:US
Practice Address - Phone:904-384-8733
Practice Address - Fax:904-384-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME23316208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71753OtherBCBS GROUP #
FL71753OtherBCBS GROUP #