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General NPI Number Information
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NPI Number | 1174656599
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Entity Type | Organization
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Legal Business Name | MINIMALLY INVASIVE SURGERY INC
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4101 N.W. 4TH STREET SUITE 401
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City | PLANTATION
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State | FL
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Zip | 33317-2813
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Country | US
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Telephone | 954-797-4220
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Fax | 954-797-4221
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Provider Business Mailing Address
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Address Line | 4101 N.W. 4TH STREET SUITE 401
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City | PLANTATION
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State | FL
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Zip | 33317-2813
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Country | US
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Telephone | 954-797-4220
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Fax | 954-797-4221
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Authorized Official
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Title or Position | SURGEON
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Name | DR. RONALD E MOORE JR.
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Credential | M.D.
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Telephone | 954-797-4220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | FL
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