Provider Demographics
NPI:1770673808
Name:MOSKOWITZ, KIMBERLY D (MS MD LLC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:MOSKOWITZ
Suffix:
Gender:F
Credentials:MS MD LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12238 PANAMA CITY BEACH PKWY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2700
Mailing Address - Country:US
Mailing Address - Phone:850-233-0264
Mailing Address - Fax:850-233-3113
Practice Address - Street 1:12238 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2700
Practice Address - Country:US
Practice Address - Phone:850-233-0265
Practice Address - Fax:850-233-3113
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5794Medicare PIN
H60791Medicare UPIN