Provider Demographics
NPI:1164602272
Name:KIMBERLY D MOSKOWITZ MS MD LLC
Entity Type:Organization
Organization Name:KIMBERLY D MOSKOWITZ MS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOSKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-233-0264
Mailing Address - Street 1:12238 PANAMA CITY BEACH PKWY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2700
Mailing Address - Country:US
Mailing Address - Phone:850-233-0264
Mailing Address - Fax:850-233-3113
Practice Address - Street 1:12238 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2700
Practice Address - Country:US
Practice Address - Phone:850-233-0264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07753OtherBCBS OF FLORIDA
FL07753OtherBCBS OF FLORIDA
FL=========OtherTRICARE
FLU5794YMedicare PIN