MEDICARE: MOSHE STAV MD PA

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	2086S0127X	Trauma Surgery Physician

General Provider Information

NPI Number	:	1558664987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSHE STAV MD PA

Provider Business Mailing Address
First Line	:	1550 PONCE DE LEON DR
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1324
Country	:	US
Telephone Number	:	954-401-6060
Fax Number	:	954-766-8434

Provider Business Practice Location Address
First Line	:	1550 PONCE DE LEON DR
Second Line	:	3200 S. UNIVERSITY DR, RM 7374
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1324
Country	:	US
Telephone Number	:	954-401-6060
Fax Number	:	954-766-8434

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MOSHE STAV
Credential	:	MD
Telephone Number	:	954-401-6060

Provider Enumeration Date	:	12/07/2010
Last Update Date	:	12/07/2010

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