Provider Demographics
NPI:1396307112
Name:AL-AHMAD, MA'MOON MOHAMMAD AMIN (MD)
Entity type:Individual
Prefix:DR
First Name:MA'MOON
Middle Name:MOHAMMAD AMIN
Last Name:AL-AHMAD
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 1:1600 SW ARCHER RD DEPT OF
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0238
Mailing Address - Country:US
Mailing Address - Phone:352-294-8278
Mailing Address - Fax:202-877-6292
Practice Address - Street 1:1600 SW ARCHER RD DEPT OF
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3017
Practice Address - Country:US
Practice Address - Phone:352-294-8278
Practice Address - Fax:202-877-6292
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME153042207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program