Healthcare Provider Details

I. General information

NPI: 1932213568
Provider Name (Legal Business Name): MOHAMMAD A ELDEEB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E CENTRAL AVE
WINTER HAVEN FL
33880-3053
US

IV. Provider business mailing address

500 E CENTRAL AVE
WINTER HAVEN FL
33880-3053
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-1191
  • Fax:
Mailing address:
  • Phone: 863-293-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberE4915
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME96382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: