Healthcare Provider Details

I. General information

NPI: 1104295807
Provider Name (Legal Business Name): DAVID MOSES RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7727 LAKE UNDERHILL RD
ORLANDO FL
32822-8224
US

IV. Provider business mailing address

7727 LAKE UNDERHILL RD
ORLANDO FL
32822-8224
US

V. Phone/Fax

Practice location:
  • Phone: 407-230-3103
  • Fax:
Mailing address:
  • Phone: 407-230-3103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT8730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: