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General NPI Number Information
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NPI Number | 1194317875
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Entity Type | Individual
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Provider Name | MOODY DUBREUZE
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Gender | Male
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Dates
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Enumeration Date | 02/04/2021
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Last Update Date | 02/04/2021
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Provider Practice Location Address
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Address Line | 2453 N STATE ROAD 7
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313-3723
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Country | US
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Telephone | 954-533-4846
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5564
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City | FORT LAUDERDALE
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State | FL
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Zip | 33310-5564
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | HCC12481
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License Number State | FL
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