Provider Demographics
NPI:1316282304
Name:MOHAMMAD M MASRI MDPA
Entity type:Organization
Organization Name:MOHAMMAD M MASRI MDPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:MILHIM
Authorized Official - Last Name:MASRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-263-2809
Mailing Address - Street 1:PO BOX 432300
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33243-2300
Mailing Address - Country:US
Mailing Address - Phone:305-412-4474
Mailing Address - Fax:
Practice Address - Street 1:9055 SW 87TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2306
Practice Address - Country:US
Practice Address - Phone:305-412-4474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOHAMMAD M MASRI MDPA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045673174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048253600Medicaid
FL048253600Medicaid