Provider Demographics
NPI:1952421208
Name:MUSTAFA, MOIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MOIZ
Middle Name:
Last Name:MUSTAFA
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:PO BOX 100119
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0119
Mailing Address - Country:US
Mailing Address - Phone:352-273-8825
Mailing Address - Fax:352-273-8800
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0119
Practice Address - Country:US
Practice Address - Phone:352-273-8825
Practice Address - Fax:352-273-8800
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME1285952086S0120X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018196800Medicaid
FLIR645ZMedicare PIN