Provider Demographics
NPI:1013274158
Name:MOONEY, JOHN HARTWELL HOUSTON (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HARTWELL HOUSTON
Last Name:MOONEY
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 43667
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-3667
Mailing Address - Country:US
Mailing Address - Phone:904-720-0599
Mailing Address - Fax:904-376-4036
Practice Address - Street 1:1348 S 18TH ST STE 200
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034
Practice Address - Country:US
Practice Address - Phone:904-261-9786
Practice Address - Fax:904-277-4143
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2018-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME136011207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease