Provider Demographics
NPI:1427075399
Name:MONA, MOHAMMED NOMAN (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:NOMAN
Last Name:MONA
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 1:710 LOMAX ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4004
Mailing Address - Country:US
Mailing Address - Phone:904-355-6583
Mailing Address - Fax:904-355-0223
Practice Address - Street 1:3599 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 905
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4252
Practice Address - Country:US
Practice Address - Phone:904-355-6583
Practice Address - Fax:904-355-0223
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0027743208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4368281OtherAETNA
FL15409OtherBLUE CROSS BLUE SHIELD
FL15409Medicare ID - Type Unspecified
D52568Medicare UPIN