Healthcare Provider Details

I. General information

NPI: 1467984146
Provider Name (Legal Business Name): MOSES BRAIMOH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 MARTIN LUTHER KING JR DR
LAFAYETTE LA
70501-1884
US

IV. Provider business mailing address

800 CLEMATIS ST STE 5-531
WEST PALM BEACH FL
33401-5107
US

V. Phone/Fax

Practice location:
  • Phone: 337-233-2437
  • Fax: 337-233-7179
Mailing address:
  • Phone: 561-514-5300
  • Fax: 561-514-5538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME143565
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number338804
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number338804
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: