Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | ME 117941 | FL |
NPI | 1376541326 |
---|---|
Provider Name | Mark E Moran |
First Address | Stuart, FL 34994-4512 |
Second Address | Stuart, FL 34994-4512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 20/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010948200 | (05) | FL |