Individual
HOUSAM MOURSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
200 AVENUE F NE, WINTER HAVEN, FL 33881-4131
(863) 293-1121
Mailing address
PO BOX 44008, PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
(904) 244-3660
(904) 244-3425
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OS0007173
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
379672800
—
FL
01
—
57301
BCBS
FL
01
—
P00346990
RR MCR
—
Enumeration date
03/07/2006
Last updated
02/14/2012
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