1578608220 NPI number — DR. SALMAN M MUDDASSIR M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578608220 NPI number — DR. SALMAN M MUDDASSIR M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MUDDASSIR

Provider First Name:

SALMAN

Provider Middle Name:

M

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1578608220

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/31/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

14690 SPRING HILL DR STE 305

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SPRING HILL

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

34609-8102

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

352-277-5348

Provider Business Mailing Address Fax Number:

352-606-2857

Provider First Line Business Practice Location Address:

9030 W FORT ISLAND TRL STE 1

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CRYSTAL RIVER

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

34429-8011

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

352-228-8906

Provider Business Practice Location Address Fax Number:

352-228-8905

Provider Enumeration Date:

02/20/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  25MA08169300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208M00000X , with the licence number: ME122573 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207R00000X , with the licence number: ME122573 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 261649038 . This is a "HORIZON BCBS" identifier . This identifiers is of the category "OTHER".
• Identifier: 0182834 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 3840780 . This is a "COVENTRY & FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 60082604 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 3580249000 . This is a "KEYSTONE HEALTH PLAN EAST PCP" identifier . This identifiers is of the category "OTHER".
• Identifier: 05200993 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 3580249000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 9474147 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 6441184 . This is a "AETNA HMO PCP" identifier . This identifiers is of the category "OTHER".
• Identifier: 110613500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".