MEDICARE: NASSER MOUKADDEM, M.D., P.A.

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	207R00000X	Internal Medicine Physician	ME71447	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110189691	OTHER	FL	RAILROAD MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831220235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NASSER MOUKADDEM, M.D., P.A.

Provider Business Mailing Address
First Line	:	4226 CENTRAL AVE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33711-1140
Country	:	US
Telephone Number	:	727-321-3915
Fax Number	:	727-328-0975

Provider Business Practice Location Address
First Line	:	4226 CENTRAL AVE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33711-1140
Country	:	US
Telephone Number	:	727-321-3915
Fax Number	:	727-328-0975

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NASSER MOUKADDEM
Credential	:	M.D.
Telephone Number	:	727-321-3915

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	12/04/2013

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Directions to “NASSER MOUKADDEM, M.D., P.A. ” Practice Location

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