Provider Demographics
NPI:1154392330
Name:JASSER, MOHAMED (MD)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:JASSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 LEIGHTON AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5700
Mailing Address - Country:US
Mailing Address - Phone:256-231-8636
Mailing Address - Fax:256-231-8684
Practice Address - Street 1:901 LEIGHTON AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5700
Practice Address - Country:US
Practice Address - Phone:256-231-8636
Practice Address - Fax:256-231-8684
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17596207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051507370Medicaid
AL051507370OtherBCBS
AL529912350Medicaid
AL631219042OtherCHAMPUS GROUP
AL051507370Medicaid
AL051507370Medicare ID - Type Unspecified