Individual
DR. MAHMOUD MOSTAFAVI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(321) 434-1771
(321) 434-1775
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-1771
(321) 434-1775
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
ME85423
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276013400
—
FL
01
—
E7650U
MEDICARE
FL
Enumeration date
10/27/2005
Last updated
04/11/2022
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