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General NPI Number Information
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NPI Number | 1205944758
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Entity Type | Individual
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Provider Name | MOIDEEN M MOOPEN MD
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Gender | Male
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 08/24/2010
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Provider Practice Location Address
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Address Line | 2400 HARBOR BLVD SUITE #19
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5038
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Country | US
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Telephone | 941-625-1391
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Fax | 941-624-0635
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Provider Business Mailing Address
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Address Line | 2400 HARBOR BLVD SUITE #19
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5038
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Country | US
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Telephone | 941-625-1391
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Fax | 941-624-0635
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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 | ME 35706
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME 35706
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License Number State | FL
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