Healthcare Provider Details

I. General information

NPI: 1295711000
Provider Name (Legal Business Name): JOSEPH E MOUHANNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 SW 62ND AVE
SOUTH MIAMI FL
33143-4955
US

IV. Provider business mailing address

7575 SW 62ND AVE
SOUTH MIAMI FL
33143-4955
US

V. Phone/Fax

Practice location:
  • Phone: 305-447-6688
  • Fax: 305-447-6588
Mailing address:
  • Phone: 305-447-6688
  • Fax: 305-447-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number650853
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: