Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME95734 | FL |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | ME95734 | FL |
N | 208000000X | Pediatrician | ME95734 | FL |
NPI | 1740281658 |
---|---|
Provider Name | Elizabeth A Moran |
First Address | Rockland, DE 19732-0191 |
Second Address | Jacksonville, FL 32207-8426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 07/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104049813A | (05) | GA |
167501 | (02) | |
275690100 | (05) | FL |