Provider Demographics
NPI:1720312440
Name:MOBILE DOCTORS OF FLORIDA PA
Entity Type:Organization
Organization Name:MOBILE DOCTORS OF FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:XUNA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-717-8181
Mailing Address - Street 1:1881 79TH STREET CSWY
Mailing Address - Street 2:2006
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4222
Mailing Address - Country:US
Mailing Address - Phone:305-717-8181
Mailing Address - Fax:
Practice Address - Street 1:1881 79TH STREET CSWY
Practice Address - Street 2:2006
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-4222
Practice Address - Country:US
Practice Address - Phone:305-439-2015
Practice Address - Fax:305-675-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4397152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621009100Medicaid
FLV05250Medicare UPIN
FL621009100Medicaid