Provider Demographics
NPI:1194740993
Name:ABOUSHAAR, MOHAMMAD HASSAN (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:HASSAN
Last Name:ABOUSHAAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:705 WELLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2982
Mailing Address - Country:US
Mailing Address - Phone:904-282-6331
Mailing Address - Fax:904-282-4117
Practice Address - Street 1:1555 KINGSLEY AVE
Practice Address - Street 2:SUITE 601
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4560
Practice Address - Country:US
Practice Address - Phone:904-264-0264
Practice Address - Fax:904-278-2437
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65257208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376161400Medicaid
FL25517SMedicare PIN
FL376161400Medicaid