Individual
DR. MOHAMAD ALASAD TOLAYMAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
820 PRUDENTIAL DR, UFJP PEDIATRIC MULTI-SPECIALTY CLINIC, JACKSONVILLE, FL 32207-8210
(904) 633-0920
(904) 633-0921
Mailing address
PO BOX 44008, UFJP PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
ME26602
FL
2080P0210X
Pediatric Nephrology Physician
Primary
ME26602
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000190517E
—
GA
05
—
0576905-00
—
FL
01
—
390007106
RAILROAD MEDICARE
FL
Enumeration date
03/21/2006
Last updated
12/07/2011
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