MEDICARE: DR. WILLIAM GUERRANT MOOREFIELD JR. MD

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	207XP3100X	Pediatric Orthopaedic Surgery Physician	16429	NC
2	207X00000X	Orthopaedic Surgery Physician	16429	NC

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093797789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM GUERRANT MOOREFIELD JR. MD

Provider Business Mailing Address
First Line	:	4601 PARK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3239
Country	:	US
Telephone Number	:	704-323-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	10650 PARK RD
Second Line	:	STE 120
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-8538
Country	:	US
Telephone Number	:	704-323-2000
Fax Number	:

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	06/04/2010

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