Provider Demographics
NPI:1093083339
Name:MATHEW MEHRDAD MOSHIRFAR DPM PA
Entity Type:Organization
Organization Name:MATHEW MEHRDAD MOSHIRFAR DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:MEHRDAD
Authorized Official - Last Name:MOSHIRFAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:941-921-5521
Mailing Address - Street 1:2190 GULF GATE DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-4813
Mailing Address - Country:US
Mailing Address - Phone:941-921-5521
Mailing Address - Fax:941-927-0609
Practice Address - Street 1:2190 GULF GATE DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4813
Practice Address - Country:US
Practice Address - Phone:941-921-5521
Practice Address - Fax:941-927-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2267213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU38724Medicare UPIN
FL65250Medicare PIN