Provider Demographics
NPI:1780779355
Name:SOUED, MOUNZER (MD)
Entity type:Individual
Prefix:
First Name:MOUNZER
Middle Name:
Last Name:SOUED
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 1:4828 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2341
Mailing Address - Country:US
Mailing Address - Phone:850-477-8109
Mailing Address - Fax:850-478-2412
Practice Address - Street 1:4531 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2770
Practice Address - Country:US
Practice Address - Phone:850-436-4563
Practice Address - Fax:850-436-4570
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78972207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL059009510OtherBCBS OF ALABAMA
4329229OtherCIGNA
7082023OtherAETNA
001928922003OtherUNITED HEALTH CARE
AL009918010Medicaid
FL257302400Medicaid
A689OtherHEALTH OPTIONS
100013112OtherRAILROAD MEDICARE
FL47273OtherBCBS OF FLORIDA
001928922003OtherUNITED HEALTH CARE
F79141Medicare UPIN