Provider Demographics
NPI:1609025642
Name:EL-GASIM, MOHAMED H (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:H
Last Name:EL-GASIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 N 16TH ST
Mailing Address - Street 2:STE 425
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4429
Mailing Address - Country:US
Mailing Address - Phone:602-476-0800
Mailing Address - Fax:602-476-0801
Practice Address - Street 1:7720 N 16TH ST
Practice Address - Street 2:STE 425
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4429
Practice Address - Country:US
Practice Address - Phone:602-476-0800
Practice Address - Fax:602-476-0801
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36344208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics