Healthcare Provider Details

I. General information

NPI: 1356802029
Provider Name (Legal Business Name): MOUWAFAK MOUREIDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 07/21/2024
Certification Date: 07/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11325 CORTEZ BLVD
SPRING HILL FL
34613-5407
US

IV. Provider business mailing address

6850 LAKE NONA BLVD
ORLANDO FL
32827-7408
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-6333
  • Fax: 352-596-0043
Mailing address:
  • Phone: 407-266-1000
  • Fax: 407-266-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME162233
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: