Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 025870 | LA |
N | 208000000X | Pediatrician | MD42693 | TN |
Y | 2080P0208X | Pediatric Infectious Diseases | 0000042693 | TN |
NPI | 1063488864 |
---|---|
Provider Name | Dr. Durward Troy Moon |
First Address | Nashville, TN 37232-0001 |
Second Address | Nashville, TN 37232-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BM9034911 | FEDERAL DEA (01) | LA |