MEDICARE: KIMBERLY D MOSKOWITZ MS MD LLC

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	207R00000X	Internal Medicine Physician	ME92500	FL

General Provider Information

NPI Number	:	1770673808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY D MOSKOWITZ MS MD LLC

Provider Business Mailing Address
First Line	:	12238 PANAMA CITY BEACH PKWY
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2700
Country	:	US
Telephone Number	:	850-233-0264
Fax Number	:	850-233-3113

Provider Business Practice Location Address
First Line	:	12238 PANAMA CITY BEACH PKWY
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2700
Country	:	US
Telephone Number	:	850-233-0265
Fax Number	:	850-233-3113

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	11/13/2012

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