Healthcare Provider Details

I. General information

NPI: 1932585015
Provider Name (Legal Business Name): MOHEB ASHRAF EMEEL GOHAR MBBCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH ST S
BIRMINGHAM AL
35249-0001
US

IV. Provider business mailing address

PO BOX 55310
BIRMINGHAM AL
35255-5310
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-4011
  • Fax:
Mailing address:
  • Phone: 205-731-9701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number41841
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: