Provider Demographics
NPI:1992703854
Name:MOSCOSO, WALTER ENRIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:ENRIQUE
Last Name:MOSCOSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6329 GAIL BLVD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2515
Mailing Address - Country:US
Mailing Address - Phone:813-788-7616
Mailing Address - Fax:813-783-2856
Practice Address - Street 1:6329 GAIL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2515
Practice Address - Country:US
Practice Address - Phone:813-788-7616
Practice Address - Fax:813-783-2856
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64743207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23307YMedicare PIN
FLF26430Medicare UPIN