Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | ME140547 | FL |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | ME140547 | FL |
NPI | 1043604390 |
---|---|
Provider Name | Dr. Mariam A. Mufti |
First Address | Gainesville, FL 32610-0107 |
Second Address | Gainesville, FL 32610-0107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2015 |
Last Update Date | 11/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103859000 | (05) | FL |