Healthcare Provider Details

I. General information

NPI: 1316938723
Provider Name (Legal Business Name): JIHAD ALI MUSTAPHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 NESBIT ST
PUNTA GORDA FL
33950-3828
US

IV. Provider business mailing address

310 NESBIT ST
PUNTA GORDA FL
33950-3828
US

V. Phone/Fax

Practice location:
  • Phone: 941-559-8995
  • Fax: 941-559-8996
Mailing address:
  • Phone: 941-559-8995
  • Fax: 941-559-8996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME154080
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: