Individual
MOHAMED A EL NEMR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
442 W HIGH ST STE 3, BRYAN, OH 43506-1681
(419) 636-4517
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
01077490A
IN
207V00000X
Obstetrics & Gynecology Physician
Primary
35.092751
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0105065
MEDICAID GROUP
OH
01
—
163460007
MEDICARE PTAN
IN
05
—
2998645
—
OH
01
—
34-1689161
TAX ID FOR JTDM FAMILY PRACTICE, LLC
OH
01
—
9934723
GROUP PTAN
OH
Enumeration date
08/23/2007
Last updated
10/10/2022
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