Individual
MAMOON JARRAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2525 HARBOR BLVD, SUITE 202, PORT CHARLOTTE, FL 33952-5317
(941) 613-3773
(941) 629-6770
Mailing address
2525 HARBOR BLVD, SUITE 202, PORT CHARLOTTE, FL 33952-5317
(941) 613-3773
(941) 629-6770
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
ME0040565
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
066974100
—
FL
01
—
08118
COMMERCIAL
FL
01
—
4652614
AETNA
FL
01
—
5744032-004
CIGNA
FL
01
—
629729
ANTHEM
FL
01
—
629729
BCBS TENNESSEE
TN
01
—
770002062
RR MEDICARE
FL
Enumeration date
06/15/2006
Last updated
02/02/2010
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