Provider Demographics
NPI:1912270802
Name:ROGER L. MOEBUS, M.D.,P.A.
Entity Type:Organization
Organization Name:ROGER L. MOEBUS, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOEBUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-663-1128
Mailing Address - Street 1:7825 SW 53RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5834
Mailing Address - Country:US
Mailing Address - Phone:305-663-1128
Mailing Address - Fax:
Practice Address - Street 1:7825 SW 53RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5834
Practice Address - Country:US
Practice Address - Phone:305-663-1128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME16263208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
78476BOtherMEDICARE P-TAN