Individual
BLAISE P MOONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12902 USF MAGNOLIA DR, MEDICAL STAFF DERVICES-MCC-FA, TAMPA, FL 33612-9416
(813) 745-2710
(813) 745-6855
Mailing address
12902 USF MAGNOLIA DR, MEDICAL STAFF DERVICES-MCC-FA, TAMPA, FL 33612-9416
(813) 745-2710
(813) 745-6855
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME99790
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001144800
—
FL
01
—
1457A
BLUE CROSS BLUE SHIELD OF FLORIDA
FL
Enumeration date
10/17/2007
Last updated
01/08/2010
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