Provider Demographics
NPI:1285900456
Name:ETAFY, MOHAMED HAMDAN MOHAMED (MD)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:HAMDAN MOHAMED
Last Name:ETAFY
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 1:1150 NW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2137
Mailing Address - Country:US
Mailing Address - Phone:305-243-4000
Mailing Address - Fax:305-243-6597
Practice Address - Street 1:1150 NW 14TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2137
Practice Address - Country:US
Practice Address - Phone:305-243-4000
Practice Address - Fax:305-243-6597
Is Sole Proprietor?:No
Enumeration Date:2012-03-31
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121626208800000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020429800Medicaid