Basic Information
Provider Information
NPI: 1932585015
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOHAR
FirstName: MOHEB ASHRAF EMEEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MBBCH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 55310
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352555310
CountryCode: US
TelephoneNumber: 2057319701
FaxNumber:  
Practice Location
Address1: 619 19TH ST S
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352490001
CountryCode: US
TelephoneNumber: 2059344011
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/30/2015
LastUpdateDate: 10/05/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/05/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207LC0200X41841ALY Allopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine

No ID Information.


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