1245761659 NPI number — AHMAD ABDELHALIM ABDELAZIZ MAHMOUD

Table of content: AHMAD ABDELHALIM ABDELAZIZ MAHMOUD (NPI 1245761659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245761659 NPI number — AHMAD ABDELHALIM ABDELAZIZ MAHMOUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHMOUD
Provider First Name:
AHMAD
Provider Middle Name:
ABDELHALIM ABDELAZIZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1245761659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 SW ARCHER RD
Provider Second Line Business Mailing Address:
DEPARTMENT OF MEDICINE, RM. 4102
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32610-0277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-265-0239
Provider Business Mailing Address Fax Number:
352-265-1107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4645 NW 8TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32605-4524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-375-1212
Provider Business Practice Location Address Fax Number:
352-371-4650
Provider Enumeration Date:
03/27/2017

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: 207R00000X , with the licence number:  ME166461 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: ME166461 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: ME166461 , 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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