Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 01036239B | IN |
NPI | 1316072366 |
---|---|
Provider Name | James Michael Moriarity |
First Address | Granger, IN 46530-8394 |
Second Address | Notre Dame, IN 46556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 26/02/2019 |