Healthcare Provider Details

I. General information

NPI: 1083095269
Provider Name (Legal Business Name): MOHAMMAD AL-MOUSILY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2015
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3009
US

IV. Provider business mailing address

1600 SW ARCHER ROAD BOX 100296
GAINESVILLE FL
32610-0001
US

V. Phone/Fax

Practice location:
  • Phone: 352-627-9350
  • Fax: 352-273-9054
Mailing address:
  • Phone: 352-273-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number52108
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD52108
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number157342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: