Healthcare Provider Details

I. General information

NPI: 1720207285
Provider Name (Legal Business Name): ANETHA MOORTHAL M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

IV. Provider business mailing address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

V. Phone/Fax

Practice location:
  • Phone: 813-778-0444
  • Fax: 813-355-5084
Mailing address:
  • Phone: 813-528-4975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME115360
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME115360
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: