MEDICARE: DR. STEVEN RAY MOFFETT 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	207VG0400X	Gynecology Physician	MD0000012333	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4280579	OTHER	TN	BCBST

General Provider Information

NPI Number	:	1588666036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN RAY MOFFETT M.D.

Provider Business Mailing Address
First Line	:	7557 DANNAHER WAY
Second Line	:	SUITE 140
City	:	POWELL
State	:	TN
Zip	:	37849-3558
Country	:	US
Telephone Number	:	865-673-9250
Fax Number	:	865-859-7368

Provider Business Practice Location Address
First Line	:	7557 DANNAHER WAY
Second Line	:	SUITE 140
City	:	POWELL
State	:	TN
Zip	:	37849-3558
Country	:	US
Telephone Number	:	865-673-9250
Fax Number	:	865-859-7368

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	03/25/2011

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