Provider Demographics
NPI:1750420626
Name:MOHAMED, AHMED MOHAMED (MD)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:MOHAMED
Last Name:MOHAMED
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 1:731 AIRPORT RD STE A
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4031
Mailing Address - Country:US
Mailing Address - Phone:850-522-4155
Mailing Address - Fax:850-522-4156
Practice Address - Street 1:731 AIRPORT RD
Practice Address - Street 2:SUITE A
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4099
Practice Address - Country:US
Practice Address - Phone:850-522-4155
Practice Address - Fax:850-522-4156
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81605174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G87824Medicare UPIN