Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 11004124 | FL |
NPI | 1316426257 |
---|---|
Provider Name | Alan Moudy |
First Address | Tallahassee, FL 32308-8402 |
Second Address | Tallahassee, FL 32308-8402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2018 |
Last Update Date | 24/01/2020 |