Provider Demographics
NPI:1396703195
Name:MAHMOUD A NIMER MD PA
Entity type:Organization
Organization Name:MAHMOUD A NIMER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:A
Authorized Official - Last Name:NIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-596-4022
Mailing Address - Street 1:14540 CORTEZ BLVD
Mailing Address - Street 2:SUITE # 113
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6056
Mailing Address - Country:US
Mailing Address - Phone:352-596-4022
Mailing Address - Fax:352-596-9851
Practice Address - Street 1:14540 CORTEZ BLVD
Practice Address - Street 2:SUITE # 113
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6056
Practice Address - Country:US
Practice Address - Phone:352-596-4022
Practice Address - Fax:352-596-9851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066235207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty