Provider Demographics
NPI:1659722973
Name:MANSOOR, MUHAMMAD A (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:A
Last Name:MANSOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5005 N. PIEDRAS STREET
Mailing Address - Street 2:WBAMC/DOM/GME
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-742-2180
Mailing Address - Fax:915-742-3238
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:
Practice Address - City:TRIPLER ARMY MEDICAL CENTER
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-1640
Practice Address - Fax:915-742-3238
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE30700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine