Provider Demographics
NPI:1245261031
Name:MOSTAFA, GAMAL (MD)
Entity type:Individual
Prefix:DR
First Name:GAMAL
Middle Name:
Last Name:MOSTAFA
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:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 TAMPA GENERAL CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3571
Practice Address - Country:US
Practice Address - Phone:813-821-8038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-148286208600000X, 2086S0102X
CT64641208600000X, 2086S0102X, 2086S0127X
NJ25MA06147500208600000X
DCMD0482372086S0102X, 2086S0127X
MI43011018952086S0102X, 208600000X
IL0361482862086S0102X, 2086S0127X
FLME1466172086S0102X, 2086S0127X
OH35.1340442086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107785800Medicaid
MI700E012740OtherBCBSM GROUP PIN
NJ25MA06147500OtherNJ LICENSE
DCMD048237OtherSTATE LICENSE
FLCO2MOOtherBCBS
MI0P30630848Medicare PIN
NC2026439AMedicare PIN