Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 27114 | AL |
NPI | 1497794945 |
---|---|
Provider Name | Dr. Marcus Moody |
First Address | Hoover, AL 35244-1203 |
Second Address | Hoover, AL 35244-1203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 22/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
150987 | (05) | AL |