Healthcare Provider Details

I. General information

NPI: 1144205543
Provider Name (Legal Business Name): MONEER M MANSOUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8787 BRYAN DAIRY RD STE 330
LARGO FL
33777-1260
US

IV. Provider business mailing address

8787 BRYAN DAIRY RD STE 330
LARGO FL
33777-1260
US

V. Phone/Fax

Practice location:
  • Phone: 727-391-8009
  • Fax: 727-391-5182
Mailing address:
  • Phone: 727-391-8009
  • Fax: 727-391-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0056911
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: