Provider Demographics
NPI:1629438635
Name:SPACE COAST LUNG & SLEEP CENTER
Entity Type:Organization
Organization Name:SPACE COAST LUNG & SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:MOATAZ
Authorized Official - Last Name:TOBAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-212-8192
Mailing Address - Street 1:205 N BANANA RIVER DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-2596
Mailing Address - Country:US
Mailing Address - Phone:931-212-8192
Mailing Address - Fax:
Practice Address - Street 1:205 N BANANA RIVER DR
Practice Address - Street 2:SUITE 105
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-2596
Practice Address - Country:US
Practice Address - Phone:931-212-8192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty