Healthcare Provider Details

I. General information

NPI: 1528913761
Provider Name (Legal Business Name): MOSS HANNON PURCELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N FLAGLER DR STE 8300
WEST PALM BEACH FL
33401-3413
US

IV. Provider business mailing address

1411 N FLAGLER DR STE 8300
WEST PALM BEACH FL
33401-3413
US

V. Phone/Fax

Practice location:
  • Phone: 561-832-1234
  • Fax: 561-832-5316
Mailing address:
  • Phone: 561-832-1234
  • Fax: 561-832-5316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9121803
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: