Provider Demographics
NPI:1033886593
Name:ELSEBEY, MOUSTAFA (MD)
Entity type:Individual
Prefix:
First Name:MOUSTAFA
Middle Name:
Last Name:ELSEBEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:954-967-6400
Mailing Address - Fax:954-337-5755
Practice Address - Street 1:550 POPE AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4679
Practice Address - Country:US
Practice Address - Phone:863-293-2144
Practice Address - Fax:863-293-3732
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLTRN34193405300000X
FLME164780208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No405300000XOther Service ProvidersPrevention Professional