Provider Demographics
NPI:1346595253
Name:JANICE A. MOODY, MD, PA
Entity Type:Organization
Organization Name:JANICE A. MOODY, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-509-3082
Mailing Address - Street 1:PO BOX 2540
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33045-2540
Mailing Address - Country:US
Mailing Address - Phone:305-292-2625
Mailing Address - Fax:305-292-2632
Practice Address - Street 1:1111 12TH ST
Practice Address - Street 2:SUITE112
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4088
Practice Address - Country:US
Practice Address - Phone:305-292-2625
Practice Address - Fax:305-292-2632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77163207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty