Provider Demographics
NPI:1497892384
Name:MOIDEEN M MOOPEN MD PA
Entity Type:Organization
Organization Name:MOIDEEN M MOOPEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MOIDEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOOPEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-625-1391
Mailing Address - Street 1:2400 HARBOR BLVD
Mailing Address - Street 2:SUITE #19
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5038
Mailing Address - Country:US
Mailing Address - Phone:941-625-1391
Mailing Address - Fax:941-624-0635
Practice Address - Street 1:2400 HARBOR BLVD
Practice Address - Street 2:SUITE #19
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5038
Practice Address - Country:US
Practice Address - Phone:941-625-1391
Practice Address - Fax:941-624-0635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME35706207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08095OtherBCBS OF FLORIDA
D84982Medicare UPIN
FL08095Medicare ID - Type Unspecified