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General NPI Number Information
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NPI Number | 1326457474
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Entity Type | Individual
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Provider Name | MOHAMED ALI ELAGNAF
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Gender | Male
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Dates
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Enumeration Date | 08/03/2014
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 11511 CANTERWOOD BLVD STE 205
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City | GIG HARBOR
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State | WA
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Zip | 98332-5818
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Country | US
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Telephone | 253-985-2949
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Fax | 253-985-2948
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Provider Business Mailing Address
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Address Line | 11511 CANTERWOOD BLVD STE 205
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City | GIG HARBOR
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State | WA
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Zip | 98332-5818
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Country | US
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Telephone | 253-985-2949
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Fax | 253-985-2948
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | MD60735787
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD60735787
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD60735787
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License Number State | WA
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