Provider Demographics
NPI:1750325569
Name:ELOUBEIDI, MOHAMADALI S (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMADALI
Middle Name:S
Last Name:ELOUBEIDI
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 1:901 LEIGHTON AVE
Mailing Address - Street 2:SUITE103
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5700
Mailing Address - Country:US
Mailing Address - Phone:256-237-1001
Mailing Address - Fax:256-237-0016
Practice Address - Street 1:901 LEIGHTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5700
Practice Address - Country:US
Practice Address - Phone:256-237-1001
Practice Address - Fax:256-237-0016
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23315207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51153806OtherBLUE CROSS BLUE SHIELD
ALH15386OtherVIVA
MS08228085OtherMISSISSIPPI MEDICAID
AL150378Medicaid
AL165429Medicaid
AL000096170OtherBLUE CROSS
AL150378Medicaid