MEDICARE: CLAY PRIMARY & FAMILY CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730186792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAY PRIMARY & FAMILY CARE LLC

Provider Business Mailing Address
First Line	:	865 BLANDING BLVD
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-8917
Country	:	US
Telephone Number	:	904-276-1133
Fax Number	:	904-276-1821

Provider Business Practice Location Address
First Line	:	865 BLANDING BLVD
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-8917
Country	:	US
Telephone Number	:	904-276-1133
Fax Number	:	904-276-1821

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. MASSOUD MOSHIREE
Credential	:	M.D.
Telephone Number	:	904-276-1133

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	07/21/2022

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Directions to “CLAY PRIMARY & FAMILY CARE LLC ” Practice Location

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