Provider Demographics
NPI:1578509329
Name:MOON, MOHAMMED NAEEM (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:NAEEM
Last Name:MOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NAEEM
Other - Middle Name:
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7448 DOCS GROVE CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8010
Mailing Address - Country:US
Mailing Address - Phone:407-352-1303
Mailing Address - Fax:407-352-3833
Practice Address - Street 1:7448 DOCS GROVE CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8010
Practice Address - Country:US
Practice Address - Phone:407-352-1303
Practice Address - Fax:407-352-3833
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072852207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG50559Medicare UPIN
FL41832YMedicare PIN