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General NPI Number Information
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NPI Number | 1497905046
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Entity Type | Individual
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Provider Name | MANSOOR S. MUGHAL M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/19/2008
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Last Update Date | 04/02/2021
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Provider Practice Location Address
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Address Line | 2 SHIRCLIFF WAY STE. 715
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City | JACKSONVILLE
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State | FL
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Zip | 32204
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Country | US
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Telephone | 904-388-8446
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Fax | 904-384-6261
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Provider Business Mailing Address
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Address Line | 1137 ASHFIELD WAY
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City | ST. JOHNS
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State | FL
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Zip | 32259
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Country | US
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Telephone | 904-388-8446
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Fax | 904-384-6261
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | R-8496
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 25MA10324500
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME145502
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License Number State | FL
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