Healthcare Provider Details

I. General information

NPI: 1871504126
Provider Name (Legal Business Name): MOHAMMED MAHMOUD MOURSI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W 7TH ST 112PV/LR
LITTLE ROCK AR
72205-5446
US

IV. Provider business mailing address

9 ALSACE CT
LITTLE ROCK AR
72223-9574
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-6864
  • Fax:
Mailing address:
  • Phone: 501-257-6864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number73333
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberE-0588
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: