Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | JM063478 | MI |
NPI | 1093797136 |
---|---|
Provider Name | Dr. James L Moeller |
First Address | Bloomfield Hills, MI 48304-0922 |
Second Address | Bloomfield Hills, MI 48304-0922 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 04/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F56260 | (02) | MI |