Provider Demographics
NPI:1205944758
Name:MOOPEN, MOIDEEN M (MD)
Entity type:Individual
Prefix:
First Name:MOIDEEN
Middle Name:M
Last Name:MOOPEN
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 1:2400 HARBOR BLVD
Mailing Address - Street 2:SUITE #19
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5038
Mailing Address - Country:US
Mailing Address - Phone:941-625-1391
Mailing Address - Fax:941-624-0635
Practice Address - Street 1:2400 HARBOR BLVD
Practice Address - Street 2:SUITE #19
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5038
Practice Address - Country:US
Practice Address - Phone:941-625-1391
Practice Address - Fax:941-624-0635
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 35706207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08095OtherBCBS OF FLORIDA
08095Medicare ID - Type Unspecified
FL08095OtherBCBS OF FLORIDA