Provider Demographics
NPI:1285612143
Name:BENMAAMER, MOUTAA (MD)
Entity type:Individual
Prefix:
First Name:MOUTAA
Middle Name:
Last Name:BENMAAMER
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 1:15730 NEW HAMPSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4121
Mailing Address - Country:US
Mailing Address - Phone:239-481-0033
Mailing Address - Fax:321-966-8322
Practice Address - Street 1:15730 NEW HAMPSHIRE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4121
Practice Address - Country:US
Practice Address - Phone:239-481-0033
Practice Address - Fax:321-966-8322
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00936742086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273543100Medicaid
FLP00289641Medicare PIN
FL273543100Medicaid
FLU5807YMedicare PIN