Provider Demographics
NPI:1407428006
Name:MOLTZ, JOSEPH ALAN (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALAN
Last Name:MOLTZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 NE 5TH TER APT 455
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2163
Mailing Address - Country:US
Mailing Address - Phone:772-646-1618
Mailing Address - Fax:
Practice Address - Street 1:575 NE 5TH TER APT 455
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2163
Practice Address - Country:US
Practice Address - Phone:772-646-1618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114264363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant