Provider Demographics
NPI:1336916329
Name:ABUSAMMOUR, MOHAMMAD YOUSEF
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:YOUSEF
Last Name:ABUSAMMOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 GOLDEN TRIANGLE BLVD APT 420
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-7443
Mailing Address - Country:US
Mailing Address - Phone:682-841-2603
Mailing Address - Fax:
Practice Address - Street 1:5001 GOLDEN TRIANGLE BLVD APT 420
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-7443
Practice Address - Country:US
Practice Address - Phone:682-841-2603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker