Provider Demographics
NPI:1790070282
Name:MOYNAHAN, DAVID FRANK (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:FRANK
Last Name:MOYNAHAN
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 1:108 PASSION FLOWER LN
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-1458
Mailing Address - Country:US
Mailing Address - Phone:850-926-9088
Mailing Address - Fax:
Practice Address - Street 1:108 PASSION FLOWER LN
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-1458
Practice Address - Country:US
Practice Address - Phone:850-926-9088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine