Organization
CANYON GATE MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICKI MOSKOW (PRESIDENT)
(954) 656-8855
Entity
Organization
Contact information
Practice address
2929 N. UNIVERSITY DR., SUITE # 110, CORAL SPRINGS, FL 33065-5081
(954) 656-8855
(954) 656-8855
Mailing address
2832 E. LAKE MEAD BLVD., SUITE E, N. LAS VEGAS, NV 89030-6550
(702) 649-5155
(702) 649-5444
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
12804
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831347731
—
NV
Enumeration date
06/10/2010
Last updated
06/10/2010
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