Provider Demographics
NPI:1942254164
Name:BEHAIRY, MOHAMED S (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:S
Last Name:BEHAIRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:M
Other - Middle Name:S
Other - Last Name:BEHAIRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD PA
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-476-9404
Mailing Address - Fax:954-476-9331
Practice Address - Street 1:817 SOUTH UNIVERSITY DRIVE
Practice Address - Street 2:SUITE #104
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:954-476-9404
Practice Address - Fax:954-476-9331
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0046368207R00000X
FLME46368207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061421100Medicaid
94565Medicare ID - Type Unspecified
D79581Medicare UPIN