Provider Demographics
NPI:1841422797
Name:MORELAND, DOUGLAS W (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:W
Last Name:MORELAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 19TH PL STE E2
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-0688
Mailing Address - Country:US
Mailing Address - Phone:772-257-5995
Mailing Address - Fax:772-257-5962
Practice Address - Street 1:1705 19TH PL STE E2
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0688
Practice Address - Country:US
Practice Address - Phone:772-257-5995
Practice Address - Fax:772-257-5962
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10340207QA0401X
FLOS 103402084A0401X, 207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002902500Medicaid
FL002902500Medicaid
FLEI943ZMedicare PIN