Provider Demographics
NPI:1245262559
Name:IRIZARRY, MOISES DUVIEL (MD)
Entity type:Individual
Prefix:
First Name:MOISES
Middle Name:DUVIEL
Last Name:IRIZARRY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 S MIAMI AVE STE 902
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4214
Mailing Address - Country:US
Mailing Address - Phone:305-396-9095
Mailing Address - Fax:305-285-2986
Practice Address - Street 1:3661 S MIAMI AVE STE 902
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4214
Practice Address - Country:US
Practice Address - Phone:305-963-9095
Practice Address - Fax:305-284-2568
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16189174400000X
FLME96980207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No174400000XOther Service ProvidersSpecialist