Provider Demographics
NPI:1992904718
Name:ANGLADE, MOISE W (MD)
Entity type:Individual
Prefix:DR
First Name:MOISE
Middle Name:W
Last Name:ANGLADE
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:PO BOX 1057
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-1057
Mailing Address - Country:US
Mailing Address - Phone:561-753-0001
Mailing Address - Fax:561-753-0005
Practice Address - Street 1:109 JOHN F KENNEDY DR STE A
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6617
Practice Address - Country:US
Practice Address - Phone:561-753-0001
Practice Address - Fax:561-753-0005
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108802207R00000X, 207RC0000X
PAMD434850207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program