Basic Information
| Provider Information | |||||||||
| NPI: | 1689802845 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | FODA | ||||||||
| FirstName: | MOHAMED | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1550 S WATER ST | ||||||||
| Address2: | |||||||||
| City: | STARKE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320914511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043682489 | ||||||||
| FaxNumber: | 9043682484 | ||||||||
| Practice Location | |||||||||
| Address1: | 6440 W NEWBERRY RD STE 202 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326054369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527926123 | ||||||||
| FaxNumber: | 3527926138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2009 | ||||||||
| LastUpdateDate: | 06/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME114110 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.