Provider Demographics
NPI:1821269846
Name:ROSSANA MOURA MD PA
Entity Type:Organization
Organization Name:ROSSANA MOURA MD PA
Other - Org Name:ROSSANA MOURA MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-874-9000
Mailing Address - Street 1:1601 N PALM AVE STE 311
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3242
Mailing Address - Country:US
Mailing Address - Phone:954-874-9000
Mailing Address - Fax:954-874-7901
Practice Address - Street 1:1601 N PALM AVE STE 311
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3242
Practice Address - Country:US
Practice Address - Phone:954-874-9000
Practice Address - Fax:954-874-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79901207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME79901OtherLICENSE
FLME79901OtherLICENSE