Provider Demographics
NPI:1477524130
Name:MOON, SUK (MD)
Entity Type:Individual
Prefix:
First Name:SUK
Middle Name:
Last Name:MOON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:250 AVENUE K SW
Mailing Address - Street 2:STE 200
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3919
Mailing Address - Country:US
Mailing Address - Phone:863-297-5400
Mailing Address - Fax:863-293-8230
Practice Address - Street 1:250 AVENUE K SW
Practice Address - Street 2:STE 200
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3919
Practice Address - Country:US
Practice Address - Phone:863-297-5400
Practice Address - Fax:863-293-8230
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2017-04-19
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Provider Licenses
StateLicense IDTaxonomies
FLME93029207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272810900Medicaid
H82779Medicare UPIN
FL272810900Medicaid