NASSER MOUKADDEM, M.D., P.A.
Osteopathic Medicine at Central Ave, Saint Petersburg, FL

License number
Florida ME71447
Category
Osteopathic Medicine
Type
Internal Medicine
Owner
Name: NASSER MOUKADDEM M.D.
Title: PRESIDENT
Phone: (727) 321-3915
Address
Address
4226 Central Ave, Saint Petersburg, FL 33711
National Provider ID: 1831220235
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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NASSER MOUKADDEM, M.D., PA

4226 Central Ave, Saint Petersburg, FL 33711

Status:
Inactive
Industry:
Medical Doctor's Office
Doing business as:
Nasser Moukaddem MD Pa
Inactive reason:
NAME CHANGE AMENDMENT
Registration:
Jul 28, 1999
Inactive since:
Aug 21, 2007
Phone:
(727) 321-3915 (Phone)
State ID:
P99000067159
Business type:
Florida Profit Corporation
Directors:
Nasser M.d Moukaddem (Director), 4226 Central Ave, Saint Petersburg, FL 33711 (Physical),Marina M.d. Barkov (Director), 4226 Central Ave, Saint Petersburg, FL 33711 (Physical)
Agent:
Kenneth Arsenault,10225 Ulmerton Rd SUITE 2, Largo, FL 33771 (Physical)
EIN:
59-3590539

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