Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | DR.0049708 | CO |
Y | 111NI0900X | Internist | DR.0049708 | CO |
N | 207R00000X | Internist | K8664 | TX |
N | 111NI0900X | Internist | K8664 | TX |
N | 207RH0002X | Hospice and Palliative Medicine | DR.0049708 | CO |
N | 207RH0002X | Hospice and Palliative Medicine | K8664 | TX |
NPI | 1386605368 |
---|---|
Provider Name | Dr. Michael Moffitt |
First Address | Pagosa Springs, CO 81147-8329 |
Second Address | Pagosa Springs, CO 81147-8329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2006 |
Last Update Date | 16/02/2017 |