Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 11014752A | IN |
NPI | 1033442991 |
---|---|
Provider Name | Dr. Dana Charles Moffatt |
First Address | Indianapolis, IN 46202-4207 |
Second Address | Indianapolis, IN 46202-4207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2009 |
Last Update Date | 10/09/2009 |