MEDICARE: MOORMAN AESTHETIC CENTER, PC

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	2086S0122X	Plastic and Reconstructive Surgery Physician

General Provider Information

NPI Number	:	1720270432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOORMAN AESTHETIC CENTER, PC

Provider Business Mailing Address
First Line	:	PO BOX 257074
Second Line	:
City	:	ST CROIX
State	:	VI
Zip	:	00824
Country	:	US
Telephone Number	:	340-719-4453
Fax Number	:	340-719-4446

Provider Business Practice Location Address
First Line	:	118 ESTATE MT WELCOME
Second Line	:
City	:	GALLOWS BAY CHRISTIANSTED
State	:	VI
Zip	:	00824
Country	:	US
Telephone Number	:	340-719-4453
Fax Number	:	340-719-4446

Authorized Official
Title or Position	:	OWNER
Name	:	GREGORY MOORMAN
Credential	:	MD
Telephone Number	:	340-719-4453

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	08/16/2007

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