Provider Demographics
NPI:1063525285
Name:WIN, MOETHU (MD)
Entity type:Individual
Prefix:DR
First Name:MOETHU
Middle Name:
Last Name:WIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:37924 MEDICAL ARTS CT
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-4323
Mailing Address - Country:US
Mailing Address - Phone:813-780-6687
Mailing Address - Fax:813-788-6554
Practice Address - Street 1:6833 MEDICAL VIEW LN
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-6614
Practice Address - Country:US
Practice Address - Phone:813-780-6687
Practice Address - Fax:813-788-6554
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 94406174400000X
FLME94406207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist