Individual
CHRISTINE E MOORHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2893 ENTERPRISE RD STE 100, DEBARY, FL 32713-2784
(386) 789-8600
(386) 789-0219
Mailing address
151 SOUTHHALL LN STE 200, MAITLAND, FL 32751-7172
(407) 875-2080
(407) 650-3455
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
A95181
CA
207N00000X
Dermatology Physician
Primary
ME105152
FL
207ND0101X
MOHS-Micrographic Surgery Physician
ME105152
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001380400
—
FL
01
—
11995801
CAQH
FL
Enumeration date
10/09/2007
Last updated
07/02/2019
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