Provider Demographics
NPI:1154395069
Name:MOATS, DAVID B (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:MOATS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3165 MCCRORY PL
Mailing Address - Street 2:SUITE 174
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3771
Mailing Address - Country:US
Mailing Address - Phone:407-423-1234
Mailing Address - Fax:407-517-1040
Practice Address - Street 1:7148 CURRY FORD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5803
Practice Address - Country:US
Practice Address - Phone:407-275-5440
Practice Address - Fax:407-282-4008
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2018-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPO 1708213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029660100Medicaid
FLP00102090OtherR/R MEDICARE
FL87972ZMedicare PIN
FL029660100Medicaid