Healthcare Provider Details

I. General information

NPI: 1053940403
Provider Name (Legal Business Name): MOHAMED ELBORAEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 USF MAGNOLIA DR
TAMPA FL
33612-9416
US

IV. Provider business mailing address

PO BOX 198441
ATLANTA GA
30384-8441
US

V. Phone/Fax

Practice location:
  • Phone: 813-745-4673
  • Fax: 813-745-1535
Mailing address:
  • Phone: 813-745-4673
  • Fax: 813-745-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME182053
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: