Provider Demographics
NPI:1023459682
Name:MOSHREF, ARIAN JOHN (DO)
Entity type:Individual
Prefix:
First Name:ARIAN
Middle Name:JOHN
Last Name:MOSHREF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10342
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33679-0342
Mailing Address - Country:US
Mailing Address - Phone:901-219-3557
Mailing Address - Fax:
Practice Address - Street 1:4555 S MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-2305
Practice Address - Country:US
Practice Address - Phone:901-219-3557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14456202K00000X, 207R00000X
SC83344207R00000X, 2086S0129X, 208M00000X
MI5101022246207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty