Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | ME136011 | FL |
NPI | 1013274158 |
---|---|
Provider Name | John Hartwell Houston Mooney |
First Address | Jacksonville, FL 32203-3667 |
Second Address | Fernandina Beach, FL 32034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2012 |
Last Update Date | 01/06/2018 |