MEDICARE: DR. LAUREN MOORHEAD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	ME119649	FL

General Provider Information

NPI Number	:	1518286319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN MOORHEAD M.D.

Provider Business Mailing Address
First Line	:	3216 W AZEELE ST STE 2
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3151
Country	:	US
Telephone Number	:	813-773-6627
Fax Number	:	813-443-6001

Provider Business Practice Location Address
First Line	:	3216 W AZEELE ST STE 2
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3151
Country	:	US
Telephone Number	:	813-773-6627
Fax Number	:	813-443-6001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2010
Last Update Date	:	09/05/2024

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