Provider Demographics
NPI:1467436246
Name:MANSOUR, ADEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEL
Middle Name:S
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 1:8880 ROYAL PALM BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5727
Mailing Address - Country:US
Mailing Address - Phone:954-983-9191
Mailing Address - Fax:866-285-7068
Practice Address - Street 1:8880 ROYAL PALM BLVD STE 105
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5727
Practice Address - Country:US
Practice Address - Phone:954-983-9191
Practice Address - Fax:866-285-7068
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075259207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G69392Medicare UPIN
E0670CMedicare ID - Type Unspecified