WISTAR MOORE III (NPI# 1326076274) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326076274 |
| Entity Type | Individual |
| Full Name | WISTAR MOORE III |
| Credential | M.D. |
| Practice Address |
3310 Waterman Way Tavares FL 32778-5250 |
| Practice Telephone | 3523431216 |
| Practice Fax Number | 3523431582 |
| Mailing Telephone | 3523431216 |
| Mailing Fax Number | 3523431582 |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2020-08-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | ME64685 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 375218600 | 05 | |
| FL | MEDICARE CITRUS CV ASSOCIATES, PL | 23256Q | 01 |
| FL | BCBS FL | 23256 | 01 |
| FL | MEDICARE STUART CV ASSOCIATES, PLLC | 23256P | 01 |
| FL | MEDICARE LEESBURG CV ASSOCIATES, LLC | 23256U | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3120 Waterman Way, Tavares, FL 32778 | 3523431216 | 3523431582 |
| 700 Doctors Ct, Leesburg, FL 347487314 | 3527879838 | 3527878705 |
| Street Address |
3310 WATERMAN WAY |
| City | TAVARES |
| State | FL |
| Zip Code | 32778-5250 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316902679 | Ronald Jason Moore | Physician Assistant | 3310 Waterman Way, Tavares, FL 32778-5250 | 2006-04-19 |
| 1023476033 | Central Florida Premier Eye Associates | Non-Pharmacy Dispensing Site | 3310 Waterman Way, Tavares, FL 32778-5250 | 2016-02-04 |
| 1942400262 | Vinay K. Gutti | Ophthalmology | 3310 Waterman Way, Tavares, FL 32778-5250 | 2007-07-24 |
| 1467533505 | Scot Corbin Holman | Ophthalmology | 3310 Waterman Way, Tavares, FL 32778-5250 | 2006-10-17 |
| 1992745418 | Mark J Vocci | Ophthalmology | 3310 Waterman Way, Tavares, FL 32778-5250 | 2006-06-07 |
| 1174563696 | Scott Wehrly | Ophthalmology | 3310 Waterman Way, Tavares, FL 32778-5250 | 2006-06-07 |
| 1972543312 | Shelby L Terpstra | Ophthalmology | 3310 Waterman Way, Tavares, FL 32778-5250 | 2006-06-07 |
| 1013956986 | Central Florida Premier Eye Associates | Ophthalmology | 3310 Waterman Way, Tavares, FL 32778-5250 | 2006-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487173753 | Erica Denise Irvin | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4681 Marsh Harbor Dr, Tavares, FL 32778 | 2017-09-18 |
| 1922522499 | J&t Divine Care | Home Health | 1554 Auburn Hills Ct, Tavares, FL 32778 | 2017-07-27 |
| 1841738721 | Kelli Maragh | Behavior Technician | 12237 Tavares Ridge Circle, Tavares, FL 32778 | 2017-02-10 |
| 1831633692 | Amanda Williams Sellers | Nurse Practitioner | 1858 Mayo Dr, Tavares, FL 32778 | 2016-12-13 |
| 1235680042 | Natalie Roaine Ash-maheux | Occupational Therapist | 4501 Waterman Way, Tavares, FL 32778 | 2016-10-17 |
| 1396295713 | Sumiko Burley- Collins | Community Health Worker | 1572 Auburn Hills Court, Tavares, FL 32778 | 2016-10-10 |
| 1295100980 | Sunshine Therapy Group, Pa | Speech-Language Pathologist | 2050 Classique Lane, Tavares, FL 32778 | 2015-12-06 |
| 1093188385 | Jana Michelle England | Counselor | 1300 Duncan, Tavares, FL 32778 | 2015-11-09 |
| 1467865980 | Reshma Balmick | Hearing Instrument Specialist | 500 West Burleigh Blvd., Tavares, FL 32778 | 2014-06-03 |
| 1861825739 | Shelagh Kathryn Wood-gouveia | Nurse Practitioner | 1390 East Burleigh Blvd., Tavares, FL 32778 | 2013-08-15 |
| Find all providers in zip 32778 | ||||
| Taxonomy Code | 208G00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Thoracic Surgery, 2007. http://www.abts.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery. Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154327872 | Gary S. Allen | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 3120 Waterman Way, Tavares, FL 32778-5252 | 2005-06-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437765898 | Leonardo Andrade Mulinari | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1120 Nw 14th St Ofc 462, Miami, FL 33136-2107 | 2020-09-21 |
| 1093344376 | Jupiter Medical Center Physicians Group Inc | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1002 S Old Dixie Hwy Ste 101, Jupiter, FL 33458-7202 | 2020-04-07 |
| 1720581937 | John J Dunning | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 12901 Bruce B Downs Blvd # 62, Tampa, FL 33612-4742 | 2018-03-14 |
| 1871020545 | Nicholas James Sears | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 450 Knights Run Ave, Suite 1406, Tampa, FL 33602-6300 | 2017-05-12 |
| 1124410857 | Miami Vein Clinics Pllc | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 8549 Coral Way, Miami, FL 33155-2335 | 2015-03-04 |
| 1861884595 | Usa Vascular Centers of Miami Pllc | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1711 E Hallandale Beach Blvd, Hallandale Beach, FL 33009-4621 | 2015-03-04 |
| 1568861995 | Modesto Peralta Jr. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 423 W Fenway Dr, Hernando, FL 34442-5144 | 2014-08-21 |
| 1477982197 | Paul Kurlansky | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2755 N Bay Rd, Miami Beach, FL 33140-4264 | 2013-11-04 |
| 1184063521 | Walter Smithwick IIi | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4708 Prince Edward Rd, Jacksonville, FL 32210-8118 | 2013-06-19 |
| 1023451937 | Leonard R. Levy | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1121 Crandon Blvd, F-701, Key Biscayne, FL 33149-2755 | 2013-04-10 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.