Provider Demographics
NPI:1629413042
Name:HAMMOUD, MOHAMAD (DO)
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:
Last Name:HAMMOUD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-549-0535
Mailing Address - Fax:321-951-7405
Practice Address - Street 1:1223 GATEWAY DR STE 2B
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2607
Practice Address - Country:US
Practice Address - Phone:321-549-0535
Practice Address - Fax:321-676-9731
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15457208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119556700Medicaid
FLKP712OtherMEDICARE