Active NPI
Donna Ruth Moore-Boatwright
- Occupational Medicine Physician
- Tavares, FL
National Provider Identifier
1932298437
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Medicine Physician
- License
- OT 10107
- Practice address
- 2762 Dora Ave
Tavares, FL 32778-4970 - Phone
- (352) 742-7837
- Fax
- (352) 742-7837
- NPI assigned
- Oct 12, 2006
- Last updated
- Aug 26, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Medicine Physician | 2083X0100X | OT 10107 | FL | Primary |
Addresses
Primary practice location
2762 Dora Ave
Tavares, FL 32778-4970
Mailing address
2762 Dora Ave
Tavares, FL 32778-4970
Phone (352) 742-7837
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 889168100 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT 10107 | FL | MD | Occupational Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219708800000",
"number": "1932298437",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2762 DORA AVE",
"city": "TAVARES",
"state": "FL",
"postal_code": "327784970",
"telephone_number": "352-742-7837",
"fax_number": "352-742-7837"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2762 DORA AVE",
"city": "TAVARES",
"state": "FL",
"postal_code": "327784970",
"telephone_number": "352-742-7837",
"fax_number": "352-742-7837"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE-BOATWRIGHT",
"first_name": "DONNA",
"middle_name": "RUTH",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-12",
"last_updated": "2008-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "2083X0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Occupational Medicine",
"state": "FL",
"license": "OT 10107",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "889168100",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tavares, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.