MEDICARE: DR. MEHDI M MOEZI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	ME80061	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	51687	OTHER	FL	BCBS
4	7767303	OTHER	FL	AETNA
5	281224	OTHER	FL	AVMED

General Provider Information

NPI Number	:	1053316190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEHDI M MOEZI MD

Provider Business Mailing Address
First Line	:	7015 AC SKINNER PARKWAY
Second Line	:	SUITE 1
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256
Country	:	US
Telephone Number	:	904-363-2113
Fax Number	:	904-363-2606

Provider Business Practice Location Address
First Line	:	2370 MARKET DR
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-4326
Country	:	US
Telephone Number	:	94-264-6201
Fax Number	:	904-264-6858

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	11/17/2014

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