Provider Demographics
NPI:1164867644
Name:MOAK, JOSEPH SAMUEL III (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SAMUEL
Last Name:MOAK
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:601 E DIXIE AVE STE 901
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5998
Mailing Address - Country:US
Mailing Address - Phone:352-728-2404
Mailing Address - Fax:352-787-7401
Practice Address - Street 1:1819 SALK AVE
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4311
Practice Address - Country:US
Practice Address - Phone:352-343-7279
Practice Address - Fax:352-343-1618
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2019-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME141155207YX0007X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty