MEDICARE: MOHAMED H ANTAR MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	ME23316	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	71753	OTHER	FL	BCBS GROUP #

General Provider Information

NPI Number	:	1225197916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOHAMED H ANTAR MD PA

Provider Business Mailing Address
First Line	:	2150 PARK ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3812
Country	:	US
Telephone Number	:	904-384-8733
Fax Number	:	904-384-9004

Provider Business Practice Location Address
First Line	:	2150 PARK ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3812
Country	:	US
Telephone Number	:	904-384-8733
Fax Number	:	904-384-9004

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MOHAMED H ANTAR
Credential	:	MD
Telephone Number	:	904-384-8733

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	07/17/2014

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