Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 12685 | FL |
NPI | 1003890286 |
---|---|
Provider Name | Herbert I Moselle |
First Address | Plantation, FL 33324-7808 |
Second Address | Plantation, FL 33324-7808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 16/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
373232100 | (05) | FL |
D51626 | (02) | FL |