Provider Demographics
NPI:1336207794
Name:MOSKOVITZ, GARY G (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:G
Last Name:MOSKOVITZ
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 1:812 W. DR. MLK JR. BLVD.,
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603
Mailing Address - Country:US
Mailing Address - Phone:813-224-9222
Mailing Address - Fax:813-224-9224
Practice Address - Street 1:812 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3338
Practice Address - Country:US
Practice Address - Phone:813-224-9222
Practice Address - Fax:813-224-9224
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61357207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17801XMedicare ID - Type Unspecified
FLF34614Medicare UPIN