| Doctor Name: | DAVID LAWERENCE MODDERS |
| NPI Number: | 1346460862 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | PY6041 |
| Business Practice Address: | 5051 Se 110th St Belleview, FL - 344203115 |
| Business Phone Number: | 3522459157 |
| Business Fax Number: | 3522453031 |
| Mailing Address: | 5051 Se 110th St, BELLEVIEW |
| State: | FL |
| Postal Code: | 344203115 |
| Phone Number: | 3522459157 |
| Fax Number: | 3522453031 |
| NPI Enumeration Date: | 04/26/2007 |
| NPI Last Update Date: | 09/21/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PY6041 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |