Andrea Wood

 
 29 Sep 2018 02:58 PM 
 TO:16103548956 FROM: 8333674956 
 Page: 14 
 Center for Advanced Surgical Spec 
 ists 
 Patient Summary Information 
 11911 N Dale Mabry Hwy 
 (813) 265xxxx 
 Tampa, FL 33618 
 Patient 
 Name: 
 Jennifer Moran
 Sex: 
 Male 
 Account: 
 C11920 
 Address: 
 1119 CR 457 
 Gender Identity: 
 DOB: 
 06 Aug 1994
 SSN: 
 263xxxxxx
 
 Referring Phys: 
 Cell. Phone: 
 email: DISCNTSIGN@AOL.COM 
 Case 
 Description: 
 C11920 RIGHT L4/L5 LAMINOTOMY'FORAMINOTOMY W/ POSSIBLE 
 ID: 34513 
 DISCECTOMY 
 Date of Service: 24 Dec 2017
 Case Provider: 
 Prada, Stefan, MD 
 Quick Code: 
 SPRADA 
 Referring Physician: 
 Prada, Stefan, MD 
 SPRADA 
 Primary Diagnosis: 
 M51.26 (Other intervertebral disc displacement, lumbar region) 
 Emergency Contact: 
 SIMONS, SHERRY 
 Phone: 
 (813) 817xxxx
 Billing Group: 
 BILL DR PRADA 

 09:03 AM 04 Oct 2018 
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