Provider Demographics
NPI:1740206028
Name:MOINFAR, NADER (MD)
Entity Type:Individual
Prefix:
First Name:NADER
Middle Name:
Last Name:MOINFAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2908
Mailing Address - Country:US
Mailing Address - Phone:863-682-7474
Mailing Address - Fax:863-802-4587
Practice Address - Street 1:2202 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2908
Practice Address - Country:US
Practice Address - Phone:863-682-7474
Practice Address - Fax:863-802-4587
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80949207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7699131OtherAETNA PPO/POS
FL1860062OtherUNITED HEALTH CARE
FL172946OtherWELL CARE
FL5796962OtherGHI
FL258286400Medicaid
FL35963OtherBCBS
FL7699131OtherAETNA HMO
FL5796962OtherGHI
FL35963OtherBCBS
FL35963YMedicare UPIN
FL1860062OtherUNITED HEALTH CARE