Provider Demographics
NPI:1225072804
Name:MOISE, MARIE EVELYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE EVELYNE
Middle Name:
Last Name:MOISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 WILSHIRE CIR W
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2200
Mailing Address - Country:US
Mailing Address - Phone:954-438-4489
Mailing Address - Fax:
Practice Address - Street 1:9900 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4048
Practice Address - Country:US
Practice Address - Phone:954-575-4940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065467207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
42341Medicare ID - Type Unspecified
B14156Medicare UPIN