Provider Demographics
NPI:1306213616
Name:MOE, WIN WIN (MD)
Entity Type:Individual
Prefix:
First Name:WIN WIN
Middle Name:
Last Name:MOE
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 1:10960 DYLAN LOREN CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4439
Mailing Address - Country:US
Mailing Address - Phone:407-420-7952
Mailing Address - Fax:407-420-7953
Practice Address - Street 1:10960 DYLAN LOREN CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4439
Practice Address - Country:US
Practice Address - Phone:407-420-7952
Practice Address - Fax:407-420-7953
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ390200000X
FLME154137207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116352100Medicaid
FLQF573OtherMEDICARE PTAN