Provider Demographics
NPI:1619298502
Name:ABD-EL-BARR, ABD-EL-RAHMAN MOSTAFA (MD)
Entity type:Individual
Prefix:
First Name:ABD-EL-RAHMAN
Middle Name:MOSTAFA
Last Name:ABD-EL-BARR
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-6050
Mailing Address - Fax:239-343-6136
Practice Address - Street 1:3100 E FLETCHER AVE STE 126
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4613
Practice Address - Country:US
Practice Address - Phone:813-756-1755
Practice Address - Fax:813-756-1756
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2024-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301096766208800000X
FLME1311802088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022057300Medicaid