Provider Demographics
NPI:1528007721
Name:MOISE, FRANCELOT (MD)
Entity Type:Individual
Prefix:MR
First Name:FRANCELOT
Middle Name:
Last Name:MOISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 NW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33167-3232
Mailing Address - Country:US
Mailing Address - Phone:305-685-5688
Mailing Address - Fax:305-688-7995
Practice Address - Street 1:3939 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-237-6409
Practice Address - Fax:954-272-6012
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I21219Medicare UPIN
FLU3558YMedicare ID - Type Unspecified