Healthcare Provider Details

I. General information

NPI: 1649292046
Provider Name (Legal Business Name): ANDREW WELLS MOULTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N MCMULLEN BOOTH RD STE B1
CLEARWATER FL
33759-2100
US

IV. Provider business mailing address

1700 N MCMULLEN BOOTH RD STE B1
CLEARWATER FL
33759-2100
US

V. Phone/Fax

Practice location:
  • Phone: 727-474-7411
  • Fax: 833-974-2140
Mailing address:
  • Phone: 727-474-7411
  • Fax: 833-974-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME96175
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME96175
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number223687
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: