Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | ME46778 | FL |
NPI | 1316979214 |
---|---|
Provider Name | Stephen P Moenning |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
271843000 | (05) | FL |
D 21254 | (02) | FL |