Healthcare Provider Details

I. General information

NPI: 1124323787
Provider Name (Legal Business Name): BEVERTON R MOXEY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 CLEVELAND CLINIC BLVD CLEVELAND CLINIC FLORIDA
WESTON FL
33331-3609
US

IV. Provider business mailing address

2950 CLEVELAND CLINIC BLVD CLEVELAND CLINIC FLORIDA
WESTON FL
33331-3609
US

V. Phone/Fax

Practice location:
  • Phone: 954-659-5646
  • Fax: 954-659-5647
Mailing address:
  • Phone: 954-659-5646
  • Fax: 954-659-5647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberTRN15590
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: