Provider Demographics
NPI:1831187640
Name:KEDAN, MOSHE (MD)
Entity type:Individual
Prefix:DR
First Name:MOSHE
Middle Name:
Last Name:KEDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 DRUID RD E
Mailing Address - Street 2:SUITE 306
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3959
Mailing Address - Country:US
Mailing Address - Phone:727-441-3761
Mailing Address - Fax:727-443-0768
Practice Address - Street 1:611 DRUID RD E
Practice Address - Street 2:SUITE 306
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3959
Practice Address - Country:US
Practice Address - Phone:727-441-3761
Practice Address - Fax:727-443-0768
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME24699207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78061OtherBLUE CROSS & BLUE SHIELD
FL78061OtherBLUE CROSS & BLUE SHIELD