Provider Demographics
NPI:1477665990
Name:NAMMOUR, HENRI HABIB (MD)
Entity type:Individual
Prefix:
First Name:HENRI
Middle Name:HABIB
Last Name:NAMMOUR
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 1:3425 S ATLANTIC AVE
Mailing Address - Street 2:UNIT 705
Mailing Address - City:DAYTONA BEACH SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:32118
Mailing Address - Country:US
Mailing Address - Phone:386-366-6126
Mailing Address - Fax:386-366-6182
Practice Address - Street 1:2381 MASON AVE SUITE 100
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-366-6126
Practice Address - Fax:386-366-6182
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90791207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E18177Medicare UPIN
FL487172Medicare ID - Type Unspecified