Provider Demographics
NPI:1992774327
Name:MOWZOON, NIMA (MD)
Entity type:Individual
Prefix:
First Name:NIMA
Middle Name:
Last Name:MOWZOON
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 1:11215 METRO PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1206
Mailing Address - Country:US
Mailing Address - Phone:239-208-2212
Mailing Address - Fax:239-208-3994
Practice Address - Street 1:11215 METRO PKWY STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1206
Practice Address - Country:US
Practice Address - Phone:239-208-2212
Practice Address - Fax:239-208-3994
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43011141582084N0400X
OH35.1255382084N0400X
TXTM006292084N0400X
ORMD1712932084N0400X
ND139092084N0400X
AZ512182084N0400X
NE286202084N0400X
NY2376862084N0400X
NH172702084N0400X
MS244962084N0400X
WAMD605950112084N0400X
FLME987762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279026200Medicaid
NH3111397Medicaid
FL007107500Medicaid
FLP00449778OtherRR MEDICARE
FLP00445784OtherRR MEDICARE
FL279026200Medicaid