=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245285238
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOHAMMED KHALED EL-YOUSEF M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2006
-----------------------------------------------------
Last Update Date | 05/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1555 S FORT HARRISON AVE
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33756-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-446-2005
-----------------------------------------------------
Fax | 727-441-2849
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1555 S FORT HARRISON AVE
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33756-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-446-2005
-----------------------------------------------------
Fax | 727-441-2849
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | ME0022323
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------