MEDICARE: ERIC EE MOUM MD

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	207N00000X	Dermatology Physician	ME0058720	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12145	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689789802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC EE MOUM MD

Provider Business Mailing Address
First Line	:	2800 S SEACREST BLVD
Second Line	:	SUITE 2800
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-7960
Country	:	US
Telephone Number	:	561-735-4300
Fax Number	:	561-735-4500

Provider Business Practice Location Address
First Line	:	2800 S SEACREST BLVD
Second Line	:	SUITE 2800
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-7960
Country	:	US
Telephone Number	:	561-735-4300
Fax Number	:	561-735-4500

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	12/09/2019

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