Provider Demographics
NPI:1104820745
Name:MUSOFF, ROY C (MD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:C
Last Name:MUSOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14530 S MILITARY TRL STE A1-A5
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-3706
Mailing Address - Country:US
Mailing Address - Phone:561-381-0260
Mailing Address - Fax:
Practice Address - Street 1:14530 S MILITARY TRL STE A1-A5
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-3706
Practice Address - Country:US
Practice Address - Phone:561-381-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59839207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377551800Medicaid
FL27115OtherGROUP # 72076
FLP00303572OtherRAILROAD MEDICARE
FL27115OtherGROUP # 72076
FLE69913Medicare UPIN