Provider Demographics
NPI:1275511081
Name:MOUSSA, HATEM M (MD)
Entity Type:Individual
Prefix:DR
First Name:HATEM
Middle Name:M
Last Name:MOUSSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2633 HWY 77
Mailing Address - Street 2:SUITE B
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4406
Mailing Address - Country:US
Mailing Address - Phone:850-215-7162
Mailing Address - Fax:850-215-7186
Practice Address - Street 1:2633 HWY 77
Practice Address - Street 2:SUITE B
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:850-215-7162
Practice Address - Fax:850-215-7186
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2010-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME95473208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277401100Medicaid
FLI44685Medicare UPIN