Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME137477 | FL |
Y | 208600000X | Surgeon | ME137477 | FL |
N | 208200000X | Surgeon | TRN24349 | FL |
N | 208600000X | Surgeon | TRN24349 | FL |
NPI | 1013440783 |
---|---|
Provider Name | Spencer Moreland |
First Address | Jacksonville, FL 32224-1865 |
Second Address | Jacksonville, FL 32224-1865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2017 |
Last Update Date | 24/10/2018 |