Healthcare Provider Details

I. General information

NPI: 1205936770
Provider Name (Legal Business Name): YOUSSEF W. WASSEF M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 NW 9TH BLVD SUITE 4
GAINESVILLE FL
32605-4269
US

IV. Provider business mailing address

PO BOX 358492
GAINESVILLE FL
32635-8492
US

V. Phone/Fax

Practice location:
  • Phone: 352-367-3422
  • Fax: 352-379-7707
Mailing address:
  • Phone: 352-367-3422
  • Fax: 352-379-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME 0070490
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: