Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 35822 | SC |
N | 207XS0106X | Orthopaedic Hand Surgeon | 35822 | SC |
Y | 2086S0105X | Surgery of the Hand | 35822 | SC |
NPI | 1427496736 |
---|---|
Provider Name | Mark Christian Moody |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29615-4240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2013 |
Last Update Date | 14/09/2020 |