Healthcare Provider Details

I. General information

NPI: 1801867445
Provider Name (Legal Business Name): ANTHONY P MORENO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 N MCMULLEN BOOTH RD STE 301
CLEARWATER FL
33761-2022
US

IV. Provider business mailing address

3251 N MCMULLEN BOOTH RD STE 301
CLEARWATER FL
33761-2022
US

V. Phone/Fax

Practice location:
  • Phone: 727-669-5300
  • Fax: 727-669-5366
Mailing address:
  • Phone: 727-669-5300
  • Fax: 727-669-5366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME68236
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: