Provider Demographics
NPI:1750465506
Name:MAHAYNI, MOHAMAD AMER (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:AMER
Last Name:MAHAYNI
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 1:3701 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-2142
Mailing Address - Country:US
Mailing Address - Phone:918-682-2700
Mailing Address - Fax:918-682-2733
Practice Address - Street 1:3701 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-2142
Practice Address - Country:US
Practice Address - Phone:918-682-2700
Practice Address - Fax:918-682-2733
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19349174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
060032399OtherRAILROAD MEDICARE
OK100032970AMedicaid