Provider Demographics
NPI:1821308503
Name:HEGAZY, MOHAMED A (MD, SA)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:A
Last Name:HEGAZY
Suffix:
Gender:M
Credentials:MD, SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 SW 189TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2449
Mailing Address - Country:US
Mailing Address - Phone:850-896-5412
Mailing Address - Fax:
Practice Address - Street 1:2550 SW 189TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-2449
Practice Address - Country:US
Practice Address - Phone:850-896-5412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHSE15674208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery