Provider Demographics
NPI:1346279171
Name:STEPHEN P. MOENNING M.D., P.A.
Entity Type:Organization
Organization Name:STEPHEN P. MOENNING M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MOENNING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-639-4646
Mailing Address - Street 1:610 E OLYMPIA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3875
Mailing Address - Country:US
Mailing Address - Phone:941-639-4646
Mailing Address - Fax:941-639-6545
Practice Address - Street 1:610 E OLYMPIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3875
Practice Address - Country:US
Practice Address - Phone:941-639-4646
Practice Address - Fax:941-639-6545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271844800Medicaid
FL72740Medicare UPIN