Provider Demographics
NPI:1295711000
Name:MOUHANNA, JOSEPH E (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:E
Last Name:MOUHANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 SW 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4955
Mailing Address - Country:US
Mailing Address - Phone:305-447-6688
Mailing Address - Fax:305-447-6588
Practice Address - Street 1:7575 SW 62ND AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4955
Practice Address - Country:US
Practice Address - Phone:305-447-6688
Practice Address - Fax:305-447-6588
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL650853207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL235537OtherAVMED
FL25838OtherBCBS
027018OtherNHP
22139OtherWELLCARE
FL375930000Medicaid
FL235537OtherAVMED
FL25838Medicare ID - Type Unspecified