Provider Demographics
NPI:1629070974
Name:MOOK SANG, BRENT D (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:D
Last Name:MOOK SANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-532-1355
Mailing Address - Fax:813-635-2613
Practice Address - Street 1:2470 BLOOMINGDALE AVE STE 223
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6403
Practice Address - Country:US
Practice Address - Phone:813-689-7139
Practice Address - Fax:813-443-8157
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME44540208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042425100Medicaid
FLD85596Medicare UPIN
FL042425100Medicaid