Provider Demographics
NPI:1841345204
Name:MARIO F MOQUETE MD LLC
Entity type:Organization
Organization Name:MARIO F MOQUETE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:FELIPE
Authorized Official - Last Name:MOQUETE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-944-0002
Mailing Address - Street 1:PO BOX 421870
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34742-1870
Mailing Address - Country:US
Mailing Address - Phone:407-944-0002
Mailing Address - Fax:407-944-0098
Practice Address - Street 1:809 E OAK ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5834
Practice Address - Country:US
Practice Address - Phone:407-944-0002
Practice Address - Fax:407-944-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78532207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G99493Medicare UPIN
46973Medicare ID - Type Unspecified