Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | NC |
NPI | 1437180783 |
---|---|
Provider Name | Michael Anthony Moody |
First Address | Durham, NC 27704-2121 |
Second Address | Durham, NC 27704-2121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 10/10/2007 |