Provider Demographics
NPI:1881220846
Name:MOHAMED, ESLAM (DO)
Entity Type:Individual
Prefix:
First Name:ESLAM
Middle Name:
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 W BRANDON BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5005
Mailing Address - Country:US
Mailing Address - Phone:813-681-5702
Mailing Address - Fax:
Practice Address - Street 1:621 W BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5005
Practice Address - Country:US
Practice Address - Phone:813-681-5702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A21465207Q00000X
FLUO7323207Q00000X
TXU1726207Q00000X
AZ010271207Q00000X
MI5101027533207Q00000X
IL036.163210207Q00000X
IN02007274A207Q00000X
MN75137207Q00000X
NY321249207Q00000X
WI81082-21207Q00000X
OH34C.000162207Q00000X
FLOS18775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine