Provider Demographics
NPI:1942289558
Name:MOQUETE, MARIO FELIPE (MD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:FELIPE
Last Name:MOQUETE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:809 E OAK ST
Mailing Address - Street 2:STE 201
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5834
Mailing Address - Country:US
Mailing Address - Phone:407-944-0002
Mailing Address - Fax:407-944-0098
Practice Address - Street 1:809 E OAK ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5834
Practice Address - Country:US
Practice Address - Phone:407-944-0002
Practice Address - Fax:407-944-0098
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2017-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME78532207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257091200Medicaid
G99493Medicare UPIN
FL46973Medicare PIN