Organization
THORACIC INNOVATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOSES DEGRAFT-JOHNSON M.D. (PHYSICIAN/OWNER)
(340) 772-2000
Entity
Organization
Contact information
Practice address
15053 SW 40TH ST, DAVIE, FL 33331-2769
(340) 772-2000
Mailing address
15053 SW 40TH ST, DAVIE, FL 33331-2769
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
ME106359
FL
Other
Enumeration date
07/08/2011
Last updated
07/21/2011
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