1063261048 NPI number — MOUSTAFA AHMED IBRAHIM HASSAN HEGAZI MBBCH

Table of content: MOUSTAFA AHMED IBRAHIM HASSAN HEGAZI MBBCH (NPI 1063261048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063261048 NPI number — MOUSTAFA AHMED IBRAHIM HASSAN HEGAZI MBBCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEGAZI
Provider First Name:
MOUSTAFA
Provider Middle Name:
AHMED IBRAHIM HASSAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MBBCH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063261048
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4325 SUN N LAKE BLVD STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEBRING
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33872-2171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-402-3763
Provider Business Mailing Address Fax Number:
863-402-3765

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4325 SUN N LAKE BLVD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SEBRING
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-402-3763
Provider Business Practice Location Address Fax Number:
863-402-3765
Provider Enumeration Date:
05/14/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  TRN39247 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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