Healthcare Provider Details

I. General information

NPI: 1508882135
Provider Name (Legal Business Name): NASSER M KAZMOUZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 STONEWOOD PARK LOOP
LAND O LAKES FL
34638-6213
US

IV. Provider business mailing address

8718 BONICA PL
LAND O LAKES FL
34637-5811
US

V. Phone/Fax

Practice location:
  • Phone: 813-873-0000
  • Fax: 813-873-3659
Mailing address:
  • Phone: 813-503-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME111513
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48659
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: