Provider Demographics
NPI:1326457474
Name:ELAGNAF, MOHAMED ALI
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ALI
Last Name:ELAGNAF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11511 CANTERWOOD BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-5818
Mailing Address - Country:US
Mailing Address - Phone:253-985-2949
Mailing Address - Fax:253-985-2948
Practice Address - Street 1:11511 CANTERWOOD BLVD STE 205
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-5818
Practice Address - Country:US
Practice Address - Phone:253-985-2949
Practice Address - Fax:253-985-2948
Is Sole Proprietor?:No
Enumeration Date:2014-08-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60735787208M00000X, 207L00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2080930Medicaid