Healthcare Provider Details

I. General information

NPI: 1124559505
Provider Name (Legal Business Name): MOHAMED M ELRAMAH D.O.,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S AVENUE A
YUMA AZ
85364-7170
US

IV. Provider business mailing address

PO BOX 9119
MOBILE AL
36691-1119
US

V. Phone/Fax

Practice location:
  • Phone: 928-344-2000
  • Fax:
Mailing address:
  • Phone: 251-460-0326
  • Fax: 251-460-2846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number1922
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number010281
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number76801
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: