Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 07000901A | IN |
Y | 222Z00000X | Podiatrist | 07000901A | IN |
NPI | 1043221443 |
---|---|
Provider Name | Christopher A Moon |
First Address | Lafayette, IN 47903-4699 |
Second Address | Frankfort, IN 46041-2824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000490972 | ANTHEM PROVIDER NUMBER (01) | IN |
200465420 | (05) | IN |
U76360 | (02) | IN |