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General NPI Number Information
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NPI Number | 1043312150
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Entity Type | Individual
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Provider Name | MOHAMMED MUNEER BASHA MD.
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Gender | Male
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 410 N MAIN ST STE 1AND2
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City | CHIEFLAND
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State | FL
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Zip | 32626-0866
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Country | US
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Telephone | 352-493-7274
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Fax | 352-496-9290
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Provider Business Mailing Address
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Address Line | 10424 SW 8TH LN
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City | GAINESVILLE
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State | FL
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Zip | 32607-6353
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Country | US
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Telephone | 352-332-4131
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Fax | 352-369-3324
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME62122
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License Number State | FL
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