Provider Demographics
NPI:1760753636
Name:BAKR, MAGED MOKHTAR (MD)
Entity Type:Individual
Prefix:
First Name:MAGED
Middle Name:MOKHTAR
Last Name:BAKR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:311 9TH ST N
Mailing Address - Street 2:STE 304
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5885
Mailing Address - Country:US
Mailing Address - Phone:239-624-2730
Mailing Address - Fax:239-624-2731
Practice Address - Street 1:311 9TH ST N
Practice Address - Street 2:STE 304
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5885
Practice Address - Country:US
Practice Address - Phone:239-624-2730
Practice Address - Fax:239-624-2731
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 122337207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1501QOtherBCBS
FLIJ623YOtherMEDICARE
FL014678700Medicaid
FL1501QOtherBCBS