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NPI Code Detail

MEDICARE: ROY H. MOFFATT, M.D., INC

MEDICARE: ROY H. MOFFATT, M.D., INC
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician

Other Identifiers

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

General Provider Information

NPI Number : 1083608681
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROY H. MOFFATT, M.D., INC
Provider Business Mailing Address
First Line : PO BOX 2311
Second Line :
City : CHATSWORTH
State : CA
Zip : 91313-2311
Country : US
Telephone Number : 818-718-9500
Fax Number : 818-718-9507
Provider Business Practice Location Address
First Line : 1420 S CENTRAL AVE
Second Line :
City : GLENDALE
State : CA
Zip : 91204-2508
Country : US
Telephone Number : 818-502-2321
Fax Number : 818-409-7708
Authorized Official
Title or Position : PRESIDENT
Name : ROY H MOFFATT
Credential : M.D.
Telephone Number : 818-502-2321
Provider Enumeration Date : 09/09/2005
Last Update Date : 02/19/2008

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