Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 24148 | CA |
NPI | 1043280985 |
---|---|
Provider Name | Rex C. Moody |
First Address | Newport Beach, CA 92660-7853 |
Second Address | Newport Beach, CA 92660-7853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T08566 | (02) | CA |