MEDICARE: DR. JOHN DAVID MOFFAT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	4301070842	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053373118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DAVID MOFFAT M.D.

Provider Business Mailing Address
First Line	:	271 MCCOY RD W
Second Line	:
City	:	GAYLORD
State	:	MI
Zip	:	49735-8253
Country	:	US
Telephone Number	:	989-731-7708
Fax Number	:	989-731-7929

Provider Business Practice Location Address
First Line	:	829 N CENTER AVE
Second Line	:	SUITE 120
City	:	GAYLORD
State	:	MI
Zip	:	49735-1595
Country	:	US
Telephone Number	:	989-731-7987
Fax Number	:	989-731-7983

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	12/23/2020

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