Basic Information
| Provider Information | |||||||||
| NPI: | 1508882135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAZMOUZ | ||||||||
| FirstName: | NASSER | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 323 S MINNESOTA ST | ||||||||
| Address2: | |||||||||
| City: | CROOKSTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 567161601 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2727 W DR MARTIN LUTHER KING JR BLVD STE 800 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336076065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138730000 | ||||||||
| FaxNumber: | 8138733659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 10/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 48659 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME111513 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 48659 | 01 | MN | STATE LICENCE NUMBER | OTHER |