Provider Demographics
NPI:1447618913
Name:ROSE-LAURE MOUSSIGNAC MD PA
Entity Type:Organization
Organization Name:ROSE-LAURE MOUSSIGNAC MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE LAURE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSSIGNAC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-923-9902
Mailing Address - Street 1:PO BOX 273776
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33427-3776
Mailing Address - Country:US
Mailing Address - Phone:561-748-2889
Mailing Address - Fax:
Practice Address - Street 1:3360 BURNS RD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4323
Practice Address - Country:US
Practice Address - Phone:561-622-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty