Provider Demographics
NPI:1508882135
Name:KAZMOUZ, NASSER M (MD)
Entity type:Individual
Prefix:DR
First Name:NASSER
Middle Name:M
Last Name:KAZMOUZ
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 1:8718 BONICA PL
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34637-5811
Mailing Address - Country:US
Mailing Address - Phone:813-503-4800
Mailing Address - Fax:
Practice Address - Street 1:2716 STONEWOOD PARK LOOP
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-6213
Practice Address - Country:US
Practice Address - Phone:813-873-0000
Practice Address - Fax:813-873-3659
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111513207Q00000X
MN48659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN48659OtherSTATE LICENCE NUMBER
MN080015476Medicare PIN
I57786Medicare UPIN
MN080015177Medicare PIN
MN48659OtherSTATE LICENCE NUMBER
MSC02171Medicare PIN