Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | ME92829 | FL |
NPI | 1023110814 |
---|---|
Provider Name | Andria Michael Mushahwar |
First Address | Nashville, TN 37219-2518 |
Second Address | Maitland, FL 32751 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 27/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
273985200 | (05) | FL |
H75423 | (02) | |
U5909Y | MEDICARE (01) | FL |