MEDICARE: NIMA MOWZOON MD

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	2084N0400X	Neurology Physician	4301114158	MI
2	2084N0400X	Neurology Physician	35.125538	OH
3	2084N0400X	Neurology Physician	TM00629	TX
4	2084N0400X	Neurology Physician	MD171293	OR
5	2084N0400X	Neurology Physician	13909	ND
6	2084N0400X	Neurology Physician	51218	AZ
7	2084N0400X	Neurology Physician	28620	NE
8	2084N0400X	Neurology Physician	237686	NY
9	2084N0400X	Neurology Physician	17270	NH
10	2084N0400X	Neurology Physician	24496	MS
11	2084N0400X	Neurology Physician	MD60595011	WA
12	2084N0400X	Neurology Physician	ME98776	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00449778	OTHER	FL	RR MEDICARE
5	P00445784	OTHER	FL	RR 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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992774327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIMA MOWZOON MD

Provider Business Mailing Address
First Line	:	11215 METRO PKWY STE 1
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-1206
Country	:	US
Telephone Number	:	239-208-2212
Fax Number	:	239-208-3994

Provider Business Practice Location Address
First Line	:	11215 METRO PKWY STE 1
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-1206
Country	:	US
Telephone Number	:	239-208-2212
Fax Number	:	239-208-3994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	01/05/2023

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Directions to “ NIMA MOWZOON MD” Practice Location

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