Healthcare Provider Details

I. General information

NPI: 1093083339
Provider Name (Legal Business Name): MATHEW MEHRDAD MOSHIRFAR DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 GULF GATE DR
SARASOTA FL
34231-4813
US

IV. Provider business mailing address

2190 GULF GATE DR
SARASOTA FL
34231-4813
US

V. Phone/Fax

Practice location:
  • Phone: 941-921-5521
  • Fax: 941-927-0609
Mailing address:
  • Phone: 941-921-5521
  • Fax: 941-927-0609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2267
License Number StateFL

VIII. Authorized Official

Name: DR. MATHEW MEHRDAD MOSHIRFAR
Title or Position: OWNER
Credential: DPM
Phone: 941-921-5521