Basic Information
| Provider Information | |||||||||
| NPI: | 1265479489 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEGRIN | ||||||||
| FirstName: | MORRIS | ||||||||
| MiddleName: | NISSIM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100806 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303840806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009012102 | ||||||||
| FaxNumber: | 4238925838 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 WEST OAK STREET | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347414924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078462266 | ||||||||
| FaxNumber: | 4075183616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 03/12/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME71289 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 41879 | 01 | FL | BLUE CROSS BLUE SHIELD FL | OTHER | 258088800 | 05 | FL | MEDICAID | 0500091085 | 01 | FL | RAILROAD MEDICARE | OTHER |