Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | ME62801 | FL |
NPI | 1144282195 |
---|---|
Provider Name | Rebecca I. Moorhead |
First Address | Ponte Vedra Beach, FL 32082 |
Second Address | Ponte Vedra Beach, FL 32082-2715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 01/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F59632 | (02) | FL |