Provider Demographics
NPI:1578513313
Name:JOUD, MOHAMMAD A (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:A
Last Name:JOUD
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 1:12900 CORTEZ BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6828
Mailing Address - Country:US
Mailing Address - Phone:352-597-8844
Mailing Address - Fax:352-597-8831
Practice Address - Street 1:12900 CORTEZ BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6828
Practice Address - Country:US
Practice Address - Phone:352-597-8844
Practice Address - Fax:352-597-8831
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78544207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258942700Medicaid
FL49868YMedicare PIN
FLH04910Medicare UPIN