Provider Demographics
NPI:1740349950
Name:MOON, ALISON O (MD)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:O
Last Name:MOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3200 3RD ST S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6056
Mailing Address - Country:US
Mailing Address - Phone:904-249-6110
Mailing Address - Fax:904-249-6119
Practice Address - Street 1:3200 3RD ST S
Practice Address - Street 2:SUITE 200
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6056
Practice Address - Country:US
Practice Address - Phone:904-249-6110
Practice Address - Fax:904-249-6119
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME81110207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00057651OtherRAILROAD MEDICARE
FLME81110OtherMEDICAL LICENSE
FL35945Medicare ID - Type Unspecified
FLME81110OtherMEDICAL LICENSE