MEDICARE: MARIO F MOQUETE 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	207RG0100X	Gastroenterology Physician	ME78532	FL

General Provider Information

NPI Number	:	1841345204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIO F MOQUETE MD LLC

Provider Business Mailing Address
First Line	:	PO BOX 421870
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34742-1870
Country	:	US
Telephone Number	:	407-944-0002
Fax Number	:	407-944-0098

Provider Business Practice Location Address
First Line	:	809 E OAK ST
Second Line	:	SUITE 201
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-5834
Country	:	US
Telephone Number	:	407-944-0002
Fax Number	:	407-944-0098

Authorized Official
Title or Position	:	MANAGER
Name	:	MARIO FELIPE MOQUETE
Credential	:	M.D.
Telephone Number	:	407-944-0002

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	09/17/2007

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