Organization
VIVANT MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAPHNEE MOISE-JOHNSON MD (PRESIDENT)
(800) 574-9491
Entity
Organization
Contact information
Practice address
6214 MEMORIAL HWY STE B, TAMPA, FL 33615-4507
(800) 574-9491
(800) 547-2802
Mailing address
6214 MEMORIAL HWY STE B, TAMPA, FL 33615-4507
(800) 574-9491
(800) 547-2802
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273932100
—
FL
Enumeration date
02/25/2020
Last updated
07/06/2021
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