Provider Demographics
NPI:1831226026
Name:OB-GYN ASSOCIATES OF MID FLORIDA PA
Entity type:Organization
Organization Name:OB-GYN ASSOCIATES OF MID FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOFFETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:352-787-1535
Mailing Address - Street 1:601 E DIXIE AVE
Mailing Address - Street 2:MEDICAL PLAZA #401
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5953
Mailing Address - Country:US
Mailing Address - Phone:352-787-1535
Mailing Address - Fax:352-787-5310
Practice Address - Street 1:601 E DIXIE AVE
Practice Address - Street 2:MEDICAL PLAZA #401
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5953
Practice Address - Country:US
Practice Address - Phone:352-787-1535
Practice Address - Fax:352-787-5310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0920Medicare ID - Type UnspecifiedGROUP NUMBER