Basic Information
| Provider Information | |||||||||
| NPI: | 1407111537 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHMOUD | ||||||||
| FirstName: | YASMIN | ||||||||
| MiddleName: | KHALDON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2410 NORTHSIDE DR | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337612236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274990356 | ||||||||
| FaxNumber: | 7277813312 | ||||||||
| Practice Location | |||||||||
| Address1: | 3717 TURMAN LOOP STE 101 | ||||||||
| Address2: | |||||||||
| City: | WESLEY CHAPEL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335447794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134020238 | ||||||||
| FaxNumber: | 8139075559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2012 | ||||||||
| LastUpdateDate: | 08/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 4301100758 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | ME127559 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 018438500 | 05 | FL | MEDICAID | P01724450 | 01 | FL | RAIL ROAD MEDICARE | OTHER |