Provider Demographics
NPI:1952097388
Name:EZZ ELDIN, MOHAMED KHALED (MD)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:KHALED
Last Name:EZZ ELDIN
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 1:28211 HALLE RAY DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7353
Mailing Address - Country:US
Mailing Address - Phone:832-474-2201
Mailing Address - Fax:
Practice Address - Street 1:1701 VETERANS DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-4928
Practice Address - Country:US
Practice Address - Phone:256-629-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program