Provider Demographics
NPI:1003890286
Name:MOSELLE, HERBERT I (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:I
Last Name:MOSELLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 NW 82ND AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7808
Mailing Address - Country:US
Mailing Address - Phone:954-472-1212
Mailing Address - Fax:954-473-8265
Practice Address - Street 1:201 NW 82ND AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7808
Practice Address - Country:US
Practice Address - Phone:954-472-1212
Practice Address - Fax:954-473-8265
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL12685207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373232100Medicaid
FL06587YMedicare PIN
FL373232100Medicaid