Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | ME80061 | FL |
NPI | 1053316190 |
---|---|
Provider Name | Dr. Mehdi M Moezi |
First Address | Jacksonville, FL 32256 |
Second Address | Fleming Island, FL 32003-4326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 17/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003107612B | (05) | GA |
260425600 | (05) | FL |
281224 | AVMED (01) | FL |
51687 | BCBS (01) | FL |
51687U | (02) | FL |
7767303 | AETNA (01) | FL |
H29994 | (02) | FL |