Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 72135 | FL |
NPI | 1043218118 |
---|---|
Provider Name | Ahad Mahootchi |
First Address | Zephyrhills, FL 33539-1059 |
Second Address | Zephyrhills, FL 33542-2522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 07/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32672 | BLUE SHIELD (01) | FL |
G40232 | (02) | FL |