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General NPI Number Information
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NPI Number | 1497892384
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Entity Type | Organization
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Legal Business Name | MOIDEEN M MOOPEN MD PA
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 09/22/2010
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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 | PHYSICIAN
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Name | MR. MOIDEEN M MOOPEN
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Credential | MD
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Telephone | 941-625-1391
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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 | ME35706
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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 | ME35706
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License Number State | FL
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