Healthcare Provider Details

I. General information

NPI: 1881801140
Provider Name (Legal Business Name): MONEER M. MANSOUR,MD.PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
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: 727-391-5782
Mailing address:
  • Phone: 727-391-8009
  • Fax: 727-391-5782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARLENE M MANSOUR
Title or Position: VICE PRESIDENT
Credential:
Phone: 727-391-8009