Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 29686 | SC |
Y | 2086S0129X | Vascular Surgeon | ME120656 | FL |
NPI | 1104041342 |
---|---|
Provider Name | Roger D Moccia |
First Address | Rockledge, FL 32955-4306 |
Second Address | Melbourne, FL 32901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2007 |
Last Update Date | 27/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
014565100 | (05) | FL |