Basic Information
| Provider Information | |||||||||
| NPI: | 1982988440 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AYOUB | ||||||||
| FirstName: | MOHAMMAD | ||||||||
| MiddleName: | RUSHDI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17577 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322457577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043991623 | ||||||||
| FaxNumber: | 9043991624 | ||||||||
| Practice Location | |||||||||
| Address1: | 3627 UNIVERSITY BLVD S | ||||||||
| Address2: | SUITE 615 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322164230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043991623 | ||||||||
| FaxNumber: | 9043991624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2011 | ||||||||
| LastUpdateDate: | 02/03/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME121183 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 013520800 | 05 | FL | MEDICAID |