Provider Demographics
NPI:1639117252
Name:ELMANSOURY, ABDELNASSER G (MD PA)
Entity type:Individual
Prefix:
First Name:ABDELNASSER
Middle Name:G
Last Name:ELMANSOURY
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13411 PARKER COMMONS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1873
Mailing Address - Country:US
Mailing Address - Phone:239-415-4900
Mailing Address - Fax:239-337-4901
Practice Address - Street 1:13411 PARKER COMMONS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1873
Practice Address - Country:US
Practice Address - Phone:239-415-4900
Practice Address - Fax:239-337-4901
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064736207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373642300Medicaid
FL373642300Medicaid