Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 37502 | TN |
NPI | 1457448599 |
---|---|
Provider Name | Brent Moody |
First Address | Nashville, TN 37203-1852 |
Second Address | Nashville, TN 37203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2006 |
Last Update Date | 18/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3884146 | (05) | TN |
G88414 | (02) |