Provider Demographics
NPI:1699189019
Name:MOULTRIE, ROBERT E II (MASTER OF EDUCATION)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:MOULTRIE
Suffix:II
Gender:M
Credentials:MASTER OF EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 LEE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1859
Mailing Address - Country:US
Mailing Address - Phone:407-960-7373
Mailing Address - Fax:407-960-7375
Practice Address - Street 1:1950 LEE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1859
Practice Address - Country:US
Practice Address - Phone:407-960-7373
Practice Address - Fax:407-960-7375
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator