Provider Demographics
NPI:1134330152
Name:MOUBAYED, AMIR (DO)
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:
Last Name:MOUBAYED
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10502 SKY FLOWER CT
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-6943
Mailing Address - Country:US
Mailing Address - Phone:419-343-6381
Mailing Address - Fax:
Practice Address - Street 1:9582 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-6992
Practice Address - Country:US
Practice Address - Phone:407-363-7115
Practice Address - Fax:407-685-6012
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS131952085R0202X
MO20120179732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019069100Medicaid