Individual
JOSEPH SAMUEL MOAK III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1819 SALK AVE, TAVARES, FL 32778-4311
(352) 343-7279
(352) 343-1618
Mailing address
601 E DIXIE AVE STE 901, LEESBURG, FL 34748-5998
(352) 728-2404
(352) 787-7401
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
ME141155
FL
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
ME141155
FL
Other
Enumeration date
05/09/2013
Last updated
07/02/2019
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