Provider Demographics
NPI:1023454535
Name:MOUM DERMATOLOGY LLC
Entity type:Organization
Organization Name:MOUM DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:EE
Authorized Official - Last Name:MOUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-735-4300
Mailing Address - Street 1:2800 S SEACREST BLVD
Mailing Address - Street 2:STE 280
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7960
Mailing Address - Country:US
Mailing Address - Phone:561-735-4300
Mailing Address - Fax:561-735-4500
Practice Address - Street 1:2800 S SEACREST BLVD
Practice Address - Street 2:STE 280
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7960
Practice Address - Country:US
Practice Address - Phone:561-735-4300
Practice Address - Fax:561-735-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058720207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12145Medicare PIN
E83291Medicare UPIN