Healthcare Provider Details

I. General information

NPI: 1346765799
Provider Name (Legal Business Name): MAMOON UR RASHID
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 WELLS RD
ORANGE PARK FL
32073-2301
US

IV. Provider business mailing address

4800 BELFORT RD
JACKSONVILLE FL
32256-6004
US

V. Phone/Fax

Practice location:
  • Phone: 904-264-9797
  • Fax: 904-264-4644
Mailing address:
  • Phone: 904-398-3385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME141729
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: