Basic Information
| Provider Information | |||||||||
| NPI: | 1316426257 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOUDY | ||||||||
| FirstName: | ALAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1965 CAPITAL CIR NE STE 200 | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323088402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506562006 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1965 CAPITAL CIR NE STE 200 | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323088402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506562006 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2018 | ||||||||
| LastUpdateDate: | 01/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0010X | 11004124 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine | 207QS0010X | 11004124 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.