Basic Information
| Provider Information | |||||||||
| NPI: | 1760753636 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKR | ||||||||
| FirstName: | MAGED | ||||||||
| MiddleName: | MOKHTAR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 311 9TH ST N | ||||||||
| Address2: | STE 304 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341025885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396242730 | ||||||||
| FaxNumber: | 2396242731 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 9TH ST N | ||||||||
| Address2: | STE 304 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341025885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396242730 | ||||||||
| FaxNumber: | 2396242731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2012 | ||||||||
| LastUpdateDate: | 08/09/2017 | ||||||||
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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 | 207RG0100X | ME 122337 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 1501Q | 01 | FL | BCBS | OTHER | IJ623Y | 01 | FL | MEDICARE | OTHER | 014678700 | 05 | FL | MEDICAID |