Provider Demographics
NPI:1598853467
Name:MOEHLE, MICHEL STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:STEVEN
Last Name:MOEHLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MICHEL
Other - Middle Name:STEVEN
Other - Last Name:MOEHLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4621 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2338
Mailing Address - Country:US
Mailing Address - Phone:850-454-1764
Mailing Address - Fax:850-494-0318
Practice Address - Street 1:4621 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2338
Practice Address - Country:US
Practice Address - Phone:850-454-1764
Practice Address - Fax:850-494-0318
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61351207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080084280OtherRRB PTAN
FL378163100Medicaid
FL080084280OtherRRB PTAN
FLD67007Medicare UPIN