Healthcare Provider Details

I. General information

NPI: 1962695098
Provider Name (Legal Business Name): MORENO SPINE AND SCOLIOSIS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 N MCMULLEN BOOTH RD STE 301
CLEARWATER FL
33761
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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberME68236
License Number StateFL

VIII. Authorized Official

Name: DR. ANTHONY P MORENO
Title or Position: OWNER/ORTHOPEDIC SPINE SURGEON
Credential: MD
Phone: 727-669-5300