Healthcare Provider Details

I. General information

NPI: 1699279638
Provider Name (Legal Business Name): MOHAMED NASSER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17180 ROYAL PALM BLVD STE 1
WESTON FL
33326-2394
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-276-1474
  • Fax: 954-385-6026
Mailing address:
  • Phone: 954-276-5685
  • Fax: 954-985-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberME161885
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: