# THORVASC PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831589803
- **Authorized official:** DR. MOSES DESMOND DEGRAFT-JOHNSON MD (OWNER)
- **Authorized official phone:** (305) 301-8283

## Contact information

- **Practice address:** 2623 CENTENNIAL BLVD, SUITE 102, TALLAHASSEE, FL 32308-0585
- **Practice address phone:** (850) 792-4722
- **Practice address fax:** (850) 792-4727
- **Mailing address:** 400 CAPITAL CIR SE, STE 18148, TALLAHASSEE, FL 32301-3802
- **Mailing address phone:** (850) 792-4722

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/29/2015
- **Last updated:** 05/18/2017