Provider Demographics
NPI:1154548014
Name:OUR FAMILY DOCTOR CLINIC PA
Entity type:Organization
Organization Name:OUR FAMILY DOCTOR CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:SALEH
Authorized Official - Last Name:BOGHDADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-907-7680
Mailing Address - Street 1:PO BOX 48315
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-0120
Mailing Address - Country:US
Mailing Address - Phone:813-907-7680
Mailing Address - Fax:813-907-2454
Practice Address - Street 1:27348 CASHFORD CIR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-8198
Practice Address - Country:US
Practice Address - Phone:813-907-7680
Practice Address - Fax:813-907-2454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care