Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OS14302 | FL |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | OS14302 | FL |
NPI | 1336529650 |
---|---|
Provider Name | Yasmin Mohiuddin |
First Address | Gainesville, FL 32611-2700 |
Second Address | Gainesville, FL 32610-8202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2015 |
Last Update Date | 08/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104128300 | (05) | FL |