Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | OS10340 | FL |
NPI | 1841422797 |
---|---|
Provider Name | Douglas W Moreland |
First Address | Vero Beach, FL 32960-0688 |
Second Address | Vero Beach, FL 32960-0688 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2009 |
Last Update Date | 21/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002902500 | (05) | FL |
G53749 | (02) | FL |