Provider Demographics
NPI:1689789802
Name:MOUM, ERIC EE (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:EE
Last Name:MOUM
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 1:2800 S SEACREST BLVD
Mailing Address - Street 2:SUITE 2800
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7960
Mailing Address - Country:US
Mailing Address - Phone:561-735-4300
Mailing Address - Fax:561-735-4500
Practice Address - Street 1:2800 S SEACREST BLVD
Practice Address - Street 2:SUITE 2800
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7960
Practice Address - Country:US
Practice Address - Phone:561-735-4300
Practice Address - Fax:561-735-4500
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058720207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12145OtherBCBS
FL12145OtherBCBS
FLHG190AMedicare PIN
FL12145XMedicare PIN